Approach to the Liver Biopsy in the Patient With Chronic Low-Level Aminotransferase Elevations

Pathologists sometimes encounter a liver biopsy from an asymptomatic patient with unexplained low-level parenchymal liver enzyme elevations. These biopsies often have minor histologic changes but are otherwise almost entirely normal. This can lead to the quandary of whether or not the features are clinically meaningful and how one must formulate a diagnosis from the possibly nonspecific findings of a near-normal biopsy. The following discussion focuses on the histologic changes that can be seen in these biopsies and the practical issues involved in making a diagnosis that provides useful information to the clinician. The literature and textbooks addressing the histologic and clinical features of these cases are reviewed with an emphasis on the clinical implications of finding nonspecific histologic alterations in these patients.