Histopathological challenges in suspected drug‐induced liver injury

Abstract

When a patient with suspected drug-induced liver injury (DILI) undergoes liver biopsy, the pathologist is confronted with two major challenges. The first and most important is to establish the pattern(s) of injury which are present. Patterns of injury represent stereotypical responses of an organ to injury and relate to specific aetiologies of liver damage. The pattern of injury and the histological details of that injury can then be analysed with respect to the patient's intercurrent diseases and medication history.The specific expertise of the pathologist can be used to weigh the prospect of DILI against the likelihood of other explanations of injury. The second challenge is to characterize specific types of injury and the severity of injury, both of which may have importance for clinical decision-making and prognosis. The pathologist's report should convey both an accurate description of the pathology as well its interpretation. K E Y W O R D Sacute hepatitis, autoimmune hepatitis, cholestasis, hepatic necrosis, hepatotoxicity

Clinicopathological features of Bu Gu Zhi‐induced liver injury, a long‐term follow‐up cohort study

“…All four investigators were aware of the diagnosis of BGZILI but were blinded to laboratory data during the slide review. An overall injury pattern was obtained according to criteria proposed by David Kleiner …”

“…However, the duration of hospitalization was significantly longer in the severe group. (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) .343…”

Drug‐Induced Liver Injury in GI Practice

“…The pattern of necrosis can be zonal versus nonzonal, and acute versus chronic hepatitis–like. ( 65 ) Acute hepatitis–like injury affects the hepatic parenchyma predominantly. Severe acute hepatitis is characterized by lobular disarray, from extensive sinusoidal architectural disruption, which correlates with a higher degree of hepatocyte apoptosis and confluent necrosis.…”

“…This usually signifies cytotoxicity secondary to toxic drug metabolites, as opposed to necrosis with immune cell infiltration suggestive of involvement of the adaptive immune system. ( 65 )…”

“…This is now an uncommon scenario, as it was associated with early formulations of contraceptive steroids. ( 65,81‐83 ) Nodular regenerative hyperplasia, typically identified with a reticulin stain, has been seen in cases of exposure to azathioprine (as a result of active metabolite 6‐thioguanine), oxaliplatin, and chlorambucil, in addition to various non–drug‐related disease states. ( 33,65,81 )…”