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Difficulty: MediumGastroenterology and Hepatology

Below are microscopic findings obtained from liver biopsies of various adult patients presenting with elevated liver enzymes or cholestatic markers. Match each histopathological description with the most appropriate disease process.

  • Hepatocyte ballooning, macrovesicular steatosis, Mallory-Denk bodies, and prominent neutrophilic infiltrateAlcoholic hepatitis
  • Florid duct lesions with noncaseating granulomatous destruction of small intrahepatic bile ductsPrimary biliary cholangitis
  • Concentric periductal 'onion skin' fibrosis causing obliteration of medium and large extrahepatic and intrahepatic bile ductsPrimary sclerosing cholangitis
  • Intense portal lymphoplasmacytic infiltrate with interface hepatitis, extending into the hepatic lobuleAutoimmune hepatitis

Answer

The accurate matches are: Hepatocyte ballooning/neutrophils with Alcoholic hepatitis; Florid duct lesions/granulomas with Primary biliary cholangitis; Concentric 'onion skin' fibrosis with Primary sclerosing cholangitis; and Lymphoplasmacytic infiltrate with Autoimmune hepatitis.
Each hepatobiliary disease possesses a signature histologic pattern on liver biopsy that reflects its distinct underlying pathophysiology. Recognizing these specific cellular infiltrates and architectural changes is critical for establishing a definitive diagnosis and guiding appropriate targeted therapy.

Step-by-Step Solution

1
Analyze the first histopathologic description focusing on Mallory-Denk bodies and a neutrophilic infiltrate.
Matched to alcoholic hepatitis.
Alcoholic liver disease uniquely features neutrophil-predominant inflammation and cytoskeletal damage (Mallory-Denk bodies) rather than a primarily lymphocytic response.
2
Evaluate the second description highlighting florid duct lesions and granulomas.
Matched to primary biliary cholangitis.
PBC is an autoimmune process causing granulomatous destruction of small, intrahepatic bile ducts.
3
Assess the third description noting concentric 'onion skin' periductal fibrosis.
Matched to primary sclerosing cholangitis.
PSC is characterized by fibro-obliterative inflammation of medium and large bile ducts, creating a classic 'onion skin' appearance.
4
Review the fourth description detailing a lymphoplasmacytic infiltrate with interface hepatitis.
Matched to autoimmune hepatitis.
Autoimmune hepatitis presents with plasma cell-rich inflammation attacking the hepatocyte junction (limiting plate).

Key Concept

Histopathologic differentiation of inflammatory and autoimmune hepatobiliary diseases
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Topics

Gastroenterology and Hepatology

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