Cite this page: Arora K. Biopsy. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/liverbiopsy.html. Accessed April 19th, 2024.
Definition / general
- 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