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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
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• 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
![Page 3: The normal liver and the liver biopsy · THE NORMAL LIVER AND THE LIVER BIOPSY Dr. L. Verset MD, PhD Department of Pathology, Institut Jules Bordet, ULB NON NEOPLASTIC LIVER PATHOLOGY](https://reader033.vdocument.in/reader033/viewer/2022051918/600a0a2a3022ea1fea0a6044/html5/thumbnails/3.jpg)
• 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
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• 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
![Page 5: The normal liver and the liver biopsy · THE NORMAL LIVER AND THE LIVER BIOPSY Dr. L. Verset MD, PhD Department of Pathology, Institut Jules Bordet, ULB NON NEOPLASTIC LIVER PATHOLOGY](https://reader033.vdocument.in/reader033/viewer/2022051918/600a0a2a3022ea1fea0a6044/html5/thumbnails/5.jpg)
NORMAL MICROANATOMY OF THE LIVER
• Functional units
• Hepatic lobule
• Acinus of Rappaport
12 23 3
↓O2 ↓O2
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PT
TV
1 2 3
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Kietzmann T. Redox Biol 2007doi: [10.1016/j.redox.2017.01.012]
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Hepatocytes- Polygonal- Nucleoli- Variation of nuclear
size and polyploidy(Old subject)
Sinusoids- Incomplete barrier
(exchange)- CD31 and CD34 -
Kupffer cells- Macrophages
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Picture from Liver Biopsy interpretation 9th edition, chapter 3, p19.
Canals of Hering
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Bile duct
Artery
Portal vein
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• 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
![Page 12: The normal liver and the liver biopsy · THE NORMAL LIVER AND THE LIVER BIOPSY Dr. L. Verset MD, PhD Department of Pathology, Institut Jules Bordet, ULB NON NEOPLASTIC LIVER PATHOLOGY](https://reader033.vdocument.in/reader033/viewer/2022051918/600a0a2a3022ea1fea0a6044/html5/thumbnails/12.jpg)
Picture from Liver Biopsy interpretation 9th edition, chapter 3, p24.
Normal liver in neonate
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CHILD ADULT
Picture from Surgical Pathology of the GI tract, Liver, Biliary tract and Pancreas 2nd Edition, p967
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Glycogenated nuclei
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Internet: https://library.med.utah.edu/WebPath/LIVEHTML/LIVER019.html
Lipofuschin
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• 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
![Page 17: The normal liver and the liver biopsy · THE NORMAL LIVER AND THE LIVER BIOPSY Dr. L. Verset MD, PhD Department of Pathology, Institut Jules Bordet, ULB NON NEOPLASTIC LIVER PATHOLOGY](https://reader033.vdocument.in/reader033/viewer/2022051918/600a0a2a3022ea1fea0a6044/html5/thumbnails/17.jpg)
PAS diastase
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Internet: https://www.pathpedia.com/education/eatlas/histopathology/liver_and_bile_ducts/alpha-1_antitrypsin_deficiency.aspx
PAS diastase
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Masson’sTrichrome
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Masson’sTrichrome
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Reticulin
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Internet: http://www.pathologyoutlines.com/topic/liverwilsonsdisease.html
Rhodanin
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Perls
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Internet: https://pdfs.semanticscholar.org/9fd5/3a66d95dec174dfa37adca87e9f3a441f57e.pdf
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Internet: https://pdfs.semanticscholar.org/9fd5/3a66d95dec174dfa37adca87e9f3a441f57e.pdf
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• 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
![Page 27: The normal liver and the liver biopsy · THE NORMAL LIVER AND THE LIVER BIOPSY Dr. L. Verset MD, PhD Department of Pathology, Institut Jules Bordet, ULB NON NEOPLASTIC LIVER PATHOLOGY](https://reader033.vdocument.in/reader033/viewer/2022051918/600a0a2a3022ea1fea0a6044/html5/thumbnails/27.jpg)
• 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?