the normal liver and the liver biopsy · the normal liver and the liver biopsy dr. l. verset md,...
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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
• 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?