Liver and intrahepatic bile ducts - nontumor
Biliary tract disease
Cholangitis lenta / sepsis

Editor-in-Chief: Debra Zynger, M.D.
Raul S. Gonzalez, M.D.

Topic Completed: 25 November 2019

Revised: 26 December 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Cholangitis lenta OR cholangiolar cholestasis

Raul S. Gonzalez, M.D.
Page views in 2019: 669
Page views in 2020 to date: 35
Cite this page: Gonzalez RS. Cholangitis lenta / sepsis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livercholangitislenta.html. Accessed January 17th, 2020.
Definition / general
  • “Cholangitis lenta” was originally a term referring to a rare clinical form of chronic sepsis (Hum Pathol 1982;13:19)
  • Now typically used by pathologists to refer to microscopic bile ductular cholestasis (Am J Surg Pathol 2017;41:1607), often in the context of sepsis
Essential features
  • “Cholangitis lenta” currently functions as a synonym for bile ductular cholestasis
  • Ductular reaction with bile ductular cholestasis is concerning (but not specific) for sepsis
Terminology
  • Additional terms include cholangiolar cholestasis or subacute nonsuppurative cholangitis (Am J Surg Pathol 2017;41:1607)
  • “Lenta” appears to mean “slow”
Pathophysiology
  • Cause of biliary abnormalities in septic patients is complex, likely multifactorial (Crit Care 2012;16:235)
Laboratory
Case reports
Microscopic (histologic) description
  • Dilated, peripherally located bile ductular reaction that contains inspissated bile
  • Other common findings include portal tract inflammation, duct injury, hepatocyte ballooning or necrosis and canalicular cholestasis (Am J Surg Pathol 2017;41:1607)
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
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Ductular cholestasis in sepsis

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Ductular cholestasis in cirrhosis

Sample pathology report
  • Liver, biopsy:
    • Biliary pattern injury with ductular reaction, prominent ductular cholestasis and moderate portal inflammation (see comment)
    • Comment: The clinical concern for liver failure is noted. The histologic findings raise the possibility of sepsis, though they are not specific for that diagnosis.
Differential diagnosis
Board review question #1
A patient presents with jaundice and general malaise. Workup indicates acute liver failure, along with an elevated white blood cell count. Liver biopsy shows the following finding:

    What is the most likely diagnosis?

  1. Acetaminophen toxicity
  2. Alpha-1 antitrypsin deficiency
  3. Primary biliary cholangitis
  4. Sepsis
Board review answer #1
Board review question #2
    The term typically used by pathologists to refer to bile ductular cholestasis is

  1. Biliary cholangitis
  2. Cholangitis lenta
  3. Fibrosing cholestatic hepatitis
  4. Obstructive cholestasis
Board review answer #2
B. Cholangitis lenta

Reference: Cholangitis lenta / sepsis

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