Liver and intrahepatic bile ducts-nontumor
Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 8 April 2012, last major update April 2012
Copyright: (c) 2004-2012, PathologyOutlines.com, Inc.
● Core biopsies are 1-3 cm by 1-2 mm, representing only .002% of total liver mass
● Adequacy important; difficult to diagnosis chronic hepatitis with less than 4 identifiable portal tracts
● Recommended to routinely obtain levels, trichrome stain (highlights type I collagen), possibly reticulin stain (highlights type III collagen framework) and iron stain (to assess iron overload)
● “Clinical history is necessary to render an interpretation rather than a description of the biopsy” - Rosai
● Difficult to differentiate well differentiated hepatocellular carcinoma from benign lesions, or poorly differentiated hepatocellular carcinoma as hepatic origin on small biopsy
● Avoid subcapsular hepatic parenchyma in interpretation, as it normally contains delicate fibrous extensions from the capsule; may show scarring out of proportion to the remainder of the biopsy (Curr Gastroenterol Rep 2000;2:27)
Features to examine
● Adequacy of biopsy, site of biopsy (is it from liver?), architecture on low power; portal tracts, lobules, central veins; assess inflammation (degree, type), necrosis, fibrosis, tumor cells
● Portal tracts: presence of vein, artery and bile duct
● Inflammation: type, severity, relationship to bile duct or other structures
● Bile duct changes: inflammation, proliferation or loss, necrosis, cholestasis, atypia
● Vascular changes: inflammation, thrombosis, thickening
● Lobular changes: inflammation, necrosis, sinusoids, cell plates, inclusions, amyloid, fibrosis
● Central veins: size and shape, inflammation and fibrosis
● Final diagnosis should include clinical data, as histologic features are usually insufficient for a nonneoplastic diagnosis
End of Liver and intrahepatic bile ducts-nontumor > Biopsy
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