EPIDEMIOLOGY More than 10 million cases per year worldwide, 2.79 million cases of tuberculosis in India. Tuberculosis is a leading killer of people who are HIN infected. About a decade back, abdominal tuberculosis accounted for 0.8 % of hospital 1 2administration . And 0.7% of surgical admissions, , with 3similar prevalence in children admitted to a hospital . Both the incidence and severity of abdominal tuberculosis are expected to increase with the increasing incidence of HIV infection in India; HIV seroprevalence was signicantly higher in patients with abdominal tuberculosis than in 6voluntary blood donors (16.6% vs 1.4) . MANUSCRIPT INTRODUCTION: Tuberculosis can quite rightly be termed India's “national disease”. The abdomen is the most common site of extra- pulmonary involvement. It is caused by mycobacterium tuberculosis and continues to be a common cause of morbidity 1and mortality in India . Both incidence and severity of abdominal tuberculosis are expected to increase with the 2, 3, 6, 9increasing incidence of HIV infection in India . It may involve any organ but till recently the liver was seldom considered to be the site of tuberculosis involvement except in few case of disseminated tuberculosis. Major i ty pat ients with hepatic tuberculosis have the milliary type consisting of widespread multiple granuloma. Classic well-formed granulomas have been observed individuals with early HIV 3, 6, & 9disease . While patients with advanced HIV disease the granulomas are less well formed are more necrotic and may 4contain abundant bacilli . Though primary tuberculosis of liver is rare, it can be involved secondarily due to pulmonary and extrapulmonary 4&5tuberculosis. This incidence is around 10-15%. Gupta et al documented incidence in 63% of hepatic involvement of pulmonary and extra pulmonary tuberculosis and 46.1% 1patient presenting as pyrexia of unknown origin So identication of risk factors and early diagnosis are the key issues for effective interventions. Keeping all these views in mind, the present study was conducted with the following objectives 1. To study liver tuberculosis in adults in relation to primary tuberculosis with clinical presentations, age and sex. 2. To correlate gross morphological appearances with histopathological features. 3. To study liver tuberculosis in adults in relation to liver function test (LFT) and cause of death. MATERIAL AND METHODS: The present study was based on autopsy material.This was a descriptive cross sectional retrospective and prospective study carried out during 4½ years at tertiary care hospital. All the adult autopsies during this 4½ years period were screened for liver TB. Details of clinical history, examination and results of various investigative procedures with particular reference to liver function tests were obtained from hospital records whenever available. Standard routine procedure were used for xation, embedding and sectioning. All sections were stained with Hematoxylin and Eosin. In selected cases special stains like Ziel Neelsen stain was also performed Acid Fast Bacilli. OBSERVATION AND RESULTS: In present study tuberculosis comprised 10.17% of all liver disease and 20% of secondary liver disease and 23.73% of all infections. Young adults were commonly affected with M: F ratio was 2:1. The commonest clinical features were fever 60%, 1, 2 & 4abdominal pain 42.86%, and weight loss 28.5% .In present study hepatic tuberculosis was secondary tuberculosis and as a part of disseminated tuberculosis. Tuberculous involvement of liver in majority cases was in the form of multiple grey white tubercles ranging from pin head to 0.5 cm with central caseation with normal intervening parenchyma. In present study the granuloma lesion were commonly seen in most of cases , while caseating granulomatous lesion were seen in case of disseminated tuberculosis (Fig. 1,2,) Though main lesion in hepatic tuberculosis is granulomatous lesion along with nonspecic changes such as fatty change, focal cellular collections, brosis are also seen. In one case which was HIV positive shows the classical picture of tuberculosis granuloma (Fig. 3). Comprised by central caseation surrounded by epithelioid cells, Langhans giant cell. Liver function test (LFT) shows nonspecic changes do not help in the diagnosis. Only 5 (14.3%) cases out of 35 showed AUTOPSY STUDY OF LIVER TUBERCULOSIS IN ADULT PATIENTS IN TERTIARY CARE HOSPITAL IN MUMBAI Original Research Paper Dr. Ujwal K. Rathod Associate Professor, Dept. of Pathology, Hinduhrudaysamrat Balasaheb Thackeray Medical College, Juhu, Mumbai-400056. X 125GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Medical Science Liver involvement in tuberculosis, through common both in pulmonary and extra pulmonary tuberculosis 1, 2 & 4is usual clinical silent . In present study we came across 35 cases of hepatic tuberculosis, comprised 10.17% of all liver disease and 20% of secondary liver disease and 23.73% of all infections. Young adults were commonly affected with M: F ratio was 2:1. The commonest clinical features were fever 60%, abdominal pain 42.86%, and weight loss 28.5% 1, 2 & 4. In present study hepatic tuberculosis was secondary tuberculosis and as a part of disseminated tuberculosis. Histology (majority cases) showed multiple granuloma comprising of central caseation surrounded by epithelioid cells and Langhans giant cell. It is a known fact that silent liver diseases are common amongst apparently healthy individuals and are sometimes diagnosed only at autopsy. ABSTRACT KEYWORDS : Liver Tuberculosis. Autopsy. Millind Patil Associate Prof., Dept of Pathology, LTMMC &GH, Sion, Mumbai-400022. Dr. Smita Santosh Chavhan* Associate Professor, Dept. of Community Medicine, Hinduhrudaysamrat Balasaheb Thackeray Medical College, Juhu, Mumbai-400056. *Corresponding Author VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Riya Rathod Medical Ofcer at MT AGRAWAL Dispensary, Mumbai. 126 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS 1, 2 & 4deranged LFT . There is slight alteration in SGOT/SGPT 5was most frequent observation with mild hyperbilirubinemia . Most of the patients came in gasping condition and died 7.within 24 hours of admission In present study 7(20%) of 35 cases of hepatic TB were known cases of pulmonary TB and 3 (8.6%) females out of 12 were pregnant. In our study AFB could be demonstrated in 2(5.7%) of 35 cases.In present study the 1, 2 & 4commonest cause of death were disseminated TB . TABLE : AGE AND SEX DISTRIBUTION OF TUBERCULOSIS CASES CHART: SIGNS AND SYMPTOMS IN TUBERCULOSIS CASES Fig. 1 Multiple caseating granuloma in hepatic TB (H & E 10x) Fig. 2 Multiple caseating granuloma in hepatic TB (H & E 40x) Fig. 3 Single caseating granuloma surrounded by epithelioid giant cells in HIV positive patient in background of fatty changes in hepatic TB (H & E 40x) CONCLUSION: It may be concluded from present study that hepatic involvement is not uncommon and hepatic tuberculosis was secondary tuberculosis and as a part of disseminated tuberculosis. Young adults were commonly affected with M: F ratio was 2:1. The commonest clinical features were fever 60%, abdominal pain 42.86%, and weight loss 28.5%1, 2 & 4. The study was conducted on the specimen collected from the mortuary and not reect the actual pattern of liver TB and emphasizes the need for further studies for early detection and treatment of the vulnerable group of people in the local population. Autopsy study is a good stepping stone towards achieving good morphological accuracy. Liver TB continue to be an important cause of morbidity and mortality in tropical countries. Early diagnosis and prompt interventions improve the survival and outcome of the disease. Since TB remains a potentially curable disease. REFERENCES: 1. A.R. Chogle : Hepatic involvement in Tuberculosis. Journal of association of physicians of India 2000;Vol 48 (2): 181-182.. 2. Kapoor VK: Abdominal tuberculosis : The Indian contribution. Indian Journal of Gastrogenterology, 1998; 17: 141. 3. Lewsin K.J.: Clinical pathologic ndings of the Liver in the AIDS Am J clin. Path. 1985; 83: 582-588. 4. D N Amrapurkar, K B Chopra, A Y Phadake, et al. Indian Journal of Gastroenterol, 1995; 14(1):21-22. 5. Gupta S, Meena H S, Chopra R. Hepatic involvement in tuberculosis. J. Assoc Physician in India 1993; 41:20-22. 6. Rathi PM, Amrapurkar DN, Chopra KB, et al. Impact of HIV infection in tuberculosis (Abstract). Indian J Gastroenterol. 1999; 12(Suppl 2):A2. 7. AS Purl AK Nayyar & JC .Vij Indian J.Tub1994; 41:131. 8. Nityanand HK Agrawal Manmeet Singh, Tuberculosis Liver TB J.Assoc Physician India. 9. Chaisson RE, Schecter GF, Theuer CP, Rutherford GW, Echenberg DF, Hopewell PC: TB in patients with the acquired immunodeciency syndrome clinical features, response to therapy and survival, Am. Rev Respir. Dis 1987; 136: 570-574. VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Sr. No. Age TB (n = 35) Male Female 1. Young adults (18-40yrs) 8 9 2. Middle age (41-60yrs) 9 2 3. Elderly (> 61) 6 1 Total 23 12