Liver & intrahepatic bile ducts



Topic Completed: 1 April 2012

Minor changes: 11 March 2020

Copyright: 2002-2021,, Inc.

PubMed Search: "Liver biopsy"[title] "loattrfree full text"[sb]

Komal Arora, M.D.
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Cite this page: Arora K. Biopsy. website. Accessed November 27th, 2021.
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
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