Primary sclerosing cholangitis (PSC) is a primary biliary disorder characterized by progressive destruction of bile ducts. In this post we will present the most classic microscopic findings of PSC, while discussing the challenges of making this diagnosis solely based on histology.
Primary biliary cholangitis (PBC) is a chronic liver disorder caused by progressive bile duct destruction. In this post, we will present the characteristic histologic findings of PBC, as well as the key histologic differentials to keep in mind when working up a liver biopsy with portal-based inflammation.
The clinical and histologic presentation of autoimmune hepatitis (AIH) can be quite variable. Here, we present the microscopic features of AIH and discuss clinicopathologic findings that can be used to narrow the differential diagnosis, including the criteria proposed by the International Autoimmune Hepatitis Group.
In patients with chronic liver disease, liver biopsies are taken to evaluate extent and progression of disease, which helps guide therapy. Here, we discuss the microscopic features of chronic hepatitis and the two most common histologic scoring systems used to evaluate liver biopsies with chronic hepatitis.
Steatohepatitis is a common finding on liver biopsies. The main differential diagnosis is non-alcoholic steatohepatitis (NASH) versus alcoholic steatohepatitis. When the histologic and clinical findings are most consistent with NASH, the liver biopsies are graded and staged based on one of the following scoring systems: the Brunt system, the NASH Clinical Research Network (NASH CRN) system, and the SAF scoring system. Here, we discuss the evaluation of liver biopsies with steatohepatitis.
Why do patients get liver biopsies? The main goals of a liver biopsy are to (1) render a diagnosis in a patient with abnormal liver function tests (LFTs) or a liver lesion on imaging, (2) provide staging and grading in a patient with a history of chronic hepatitis, (3) assess the liver’s response to treatment, and (4) assess the function of a liver transplant.