Liver and intrahepatic bile ducts - nontumor
Biliary tract disease
Ductular reaction

Topic Completed: 1 February 2012

Revised: 6 December 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Ductular reaction[TI] liver

Deepali Jain, M.D.
Page views in 2019: 38
Page views in 2020 to date: 173
Cite this page: Jain D. Ductular reaction. website. Accessed February 21st, 2020.
Definition / general
  • Bile ductular proliferation due to ductular metaplasia of hepatocytes and from proliferation of preexisting bile ductules
  • Associated with cirrhosis, submassive hepatic necrosis, biliary tract disorders, atrophy and focal nodular hyperplasia
Gross description
  • Often multiple irregular nodules
Microscopic (histologic) description
  • Periductular neutrophils common
  • No angulated structures, usually no dense fibrosis (except with atrophy), variable bile in portal tract or periportal area
Positive staining - disease
Differential diagnosis
  • Adenocarcinoma: particularly confusing after chemotherapy, has more severe atypia with irregular nuclear membranes, prominent nucleoli, hyperchromasia, increased N/C ratio, desmoplasia, infiltrative cells
  • Bile duct adenoma: solitary, subcapsular, with collapsed lumina, prominent lymphocytes
  • Bile duct hamartoma: angulated ducts embedded in sclerotic stroma
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