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Difficulty: HardGastroenterology and Hepatology

Match each hepatobiliary disorder with its most characteristic histopathologic finding on liver biopsy.

  • Primary biliary cholangitisFlorid duct lesions with granulomatous destruction of interlobular bile ducts
  • Primary sclerosing cholangitisConcentric 'onion skin' periductal fibrosis obliterating bile ducts
  • Autoimmune hepatitisProminent lymphoplasmacytic infiltrate causing interface hepatitis
  • Alpha-1 antitrypsin deficiencyPAS-positive, diastase-resistant globular inclusions in periportal hepatocytes
  • Non-alcoholic steatohepatitisMacrovesicular steatosis, hepatocyte ballooning, and Mallory-Denk bodies

Answer

Primary biliary cholangitis matches with florid duct lesions. Primary sclerosing cholangitis matches with 'onion skin' periductal fibrosis. Autoimmune hepatitis matches with prominent lymphoplasmacytic infiltrate causing interface hepatitis. Alpha-1 antitrypsin deficiency matches with PAS-positive, diastase-resistant globular inclusions. Non-alcoholic steatohepatitis matches with macrovesicular steatosis and Mallory-Denk bodies.
Each hepatobiliary condition possesses distinctly unique histopathological hallmarks essential for definitive diagnosis when clinical and serological findings are equivocal. Recognizing these specific liver biopsy patterns allows for appropriate diagnosis and guides distinct therapeutic management strategies for each chronic liver disease.

Step-by-Step Solution

1
Evaluate the histologic finding of 'onion skin' periductal fibrosis.
This is paired with Primary sclerosing cholangitis.
This finding represents the progressive fibro-obliteration of bile ducts characteristic of primary sclerosing cholangitis.
2
Evaluate the histologic finding of florid duct lesions and granulomas.
This is paired with Primary biliary cholangitis.
Primary biliary cholangitis specifically targets small, interlobular intrahepatic bile ducts with granulomatous inflammation.
3
Evaluate the histologic finding of interface hepatitis with plasma cells.
This is paired with Autoimmune hepatitis.
A lymphoplasmacytic infiltrate spilling into the lobules is the histopathologic hallmark of autoimmune hepatitis.
4
Evaluate the histologic finding of PAS-positive, diastase-resistant inclusions.
This is paired with Alpha-1 antitrypsin deficiency.
These inclusions represent unsecreted, misfolded alpha-1 antitrypsin protein trapped in the endoplasmic reticulum of hepatocytes.
5
Evaluate the histologic finding of steatosis with ballooning and Mallory-Denk bodies.
This is paired with Non-alcoholic steatohepatitis.
These distinct findings define steatohepatitis, distinguishing it from simple hepatic steatosis.

Key Concept

Histopathologic diagnosis of chronic hepatobiliary diseases
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Topics

Gastroenterology and Hepatology

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