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Review
. 2020 Jan;11(1):40-47.
doi: 10.1136/flgastro-2018-101139. Epub 2019 Mar 2.

Medical liver biopsy: background, indications, procedure and histopathology

Alexander Boyd  1   2   3 , Owen Cain  4 , Abhishek Chauhan  1   2   3 , Gwilym James Webb  2   5
Affiliations
Review

Medical liver biopsy: background, indications, procedure and histopathology

Alexander Boyd et al. Frontline Gastroenterol. 2020 Jan.

Abstract

Histological analysis of liver tissue continues to play an important role in modern hepatological practice. This review explores the indications for medical liver biopsy in addition to the procedure itself, potential complications, preparation of tissue and routine staining. A broad selection of histological images is included to illustrate the appearance of liver tissue both in health and in several important diseases.

Keywords: histopathology; liver; liver biopsy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Reticulin stain showing normal liver parenchyma with a portal tract in the top left of the image (P) and a central vein in the bottom right (V). Zones 1–3 are labelled.
Figure 2
Figure 2
Top left—haematoxylin van Gieson (HvG) stain showing mild zone 3 steatosis without fibrosis, in which collagen fibres (pink–red, arrow) are confined to portal tracts (P). Top right—HvG stain showing steatohepatitis with mild fibrosis in the form of fibrous expansion (arrow) of the portal tract (P). Note the presence of steatosis (S). Bottom left—HvG stain showing steatohepatitis with moderate fibrosis, with thin fibrous bridges (arrow) linking adjacent portal tracts (P). Bottom right—HvG stain showing steatohepatitis with established cirrhosis, with thick bands of fibrosis (arrows) encircling a hepatocyte nodule.
Figure 3
Figure 3
Top left—H&E stain showing scattered large and medium-size droplet steatosis and hepatocyte ballooning in the centre of the field, composed of a hepatocyte (H) with swollen optically clear cytoplasm containing a Mallory-Denk body. Top right—Perls’ stain showing heavy iron deposition in hepatocytes and biliary epithelium (a bile duct is present in the centre of the image) in the context of HFE haemochromatosis. Bottom right—PAS-D stain showing numerous PAS-D-positive globules within hepatocyte cytoplasm, adjacent to a portal tract (bottom centre of image). Globules tend to be concentrated in periportal hepatocytes. Bottom left—H&E stain showing typical changes of Budd-Chiari syndrome with dilated and relatively empty sinusoids, with numerous red blood cells translocated into the space of Disse (arrows).
Figure 4
Figure 4
Top left—H&E stain showing acute hepatitis with lobular disarray and associated lymphocytic inflammation, acidophil body formation (arrow) and bilirubinostasis. Top right—H&E stain showing features of chronic hepatitis in the context of chronic hepatitis B infection. There is a moderately dense portal infiltrate comprising predominantly lymphocytes, showing conspicuous interface activity (arrow). L, lobule; P, portal tract. Bottom right—H&E stain showing the classical changes of primary biliary cholangitis with a florid granulomatous inflammatory bile duct lesion. The residual damaged duct is seen in the centre of the image (arrow). Bottom left—H&E stain showing concentric fibrosis surrounding an inflamed bile duct, a typical change of primary sclerosing cholangitis.
See this image and copyright information in PMC

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