THE NORMAL LIVER AND THE LIVER

BIOPSY

Dr. L. Verset MD, PhD

Department of Pathology, Institut Jules Bordet, ULB

NON NEOPLASTIC LIVER PATHOLOGY

WORKING GROUP OF DIGESTIVE PATHOLOGY

• TYPES OF SAMPLE

• NORMAL MICROANATOMY OF LIVER

• SPECIAL CONSIDERATIONS REGARDING AGES

• SPECIAL STAINS

• HOW TO REPORT LIVER BIOPSY?

THE NORMAL LIVER AND THE LIVER BIOPSY

• Percutaneous biopsy• Most common

• Least expensive

• Adequate specimen

• Transjugular (transvenous) biopsy• Catheter through the internal jugular vein, right

atrium and inferior vena cava

• Expensive

• Fragmented specimens (experience of operator)

• Laparoscopic• Most invasive and expensive method

• Laparoscopic bariatric surgery

TYPES OF SAMPLE

• TYPES OF SAMPLE

• NORMAL MICROANATOMY OF LIVER

• SPECIAL CONSIDERATIONS REGARDING AGES

• SPECIAL STAINS

• HOW TO REPORT LIVER BIOPSY?

THE NORMAL LIVER AND THE LIVER BIOPSY

NORMAL MICROANATOMY OF THE LIVER

• Functional units

• Hepatic lobule

• Acinus of Rappaport

12 23 3

↓O2 ↓O2

PT

TV

1 2 3

Kietzmann T. Redox Biol 2007doi: [10.1016/j.redox.2017.01.012]

Hepatocytes- Polygonal- Nucleoli- Variation of nuclear

size and polyploidy(Old subject)

Sinusoids- Incomplete barrier

(exchange)- CD31 and CD34 -

Kupffer cells- Macrophages

Picture from Liver Biopsy interpretation 9th edition, chapter 3, p19.

Canals of Hering

Bile duct

Artery

Portal vein

• TYPES OF SAMPLE

• NORMAL MICROANATOMY OF LIVER

• SPECIAL CONSIDERATIONS REGARDING AGES

• SPECIAL STAINS

• HOW TO REPORT LIVER BIOPSY?

THE NORMAL LIVER AND THE LIVER BIOPSY

Picture from Liver Biopsy interpretation 9th edition, chapter 3, p24.

Normal liver in neonate

CHILD ADULT

Picture from Surgical Pathology of the GI tract, Liver, Biliary tract and Pancreas 2nd Edition, p967

Glycogenated nuclei

Internet: https://library.med.utah.edu/WebPath/LIVEHTML/LIVER019.html

Lipofuschin

• TYPES OF SAMPLE

• NORMAL MICROANATOMY OF LIVER

• SPECIAL CONSIDERATIONS REGARDING AGES

• SPECIAL STAINS

• HOW TO REPORT LIVER BIOPSY?

THE NORMAL LIVER AND THE LIVER BIOPSY

PAS diastase

Internet: https://www.pathpedia.com/education/eatlas/histopathology/liver_and_bile_ducts/alpha-1_antitrypsin_deficiency.aspx

PAS diastase

Masson’sTrichrome

Masson’sTrichrome

Reticulin

Internet: http://www.pathologyoutlines.com/topic/liverwilsonsdisease.html

Rhodanin

Perls

Internet: https://pdfs.semanticscholar.org/9fd5/3a66d95dec174dfa37adca87e9f3a441f57e.pdf

Internet: https://pdfs.semanticscholar.org/9fd5/3a66d95dec174dfa37adca87e9f3a441f57e.pdf

• TYPES OF SAMPLE

• NORMAL MICROANATOMY OF LIVER

• SPECIAL CONSIDERATIONS REGARDING AGES

• SPECIAL STAINS

• HOW TO REPORT LIVER BIOPSY?

THE NORMAL LIVER AND THE LIVER BIOPSY

• SIZE

• Accuracy of the specimen (ideally 1,5 cm)

• NUMBER OF PORTAL TRACTS

• DESCRIPTION OF PORTAL TRACTS AND HEPATIC LOBULE

• ANCILLARY STUDIES

• Special stains

• Immunohistochemistry

HOW TO REPORT LIVER BIOPSY?