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Difference between revisions of "Primary biliary cholangitis"
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Primary biliary cholangitis (view source)
Revision as of 21:08, 25 August 2016
, 21:08, 25 August 2016→Images: Added a case & adjusted matters for old cases with minor edits
(→Images: added a case without definite granulomas) |
(→Images: Added a case & adjusted matters for old cases with minor edits) |
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*[http://www.gidesigns.net/images/MC-copper-flower-garland-L.jpg Garland - wreath of flowers (gidesigns.net)]. | *[http://www.gidesigns.net/images/MC-copper-flower-garland-L.jpg Garland - wreath of flowers (gidesigns.net)]. | ||
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[[File:1 PBC 4 680x512px.tif|Inflamed triads [arrows] amid undisturbed hepatocytes (Row 1 Left 40X).]] | |||
[[File:2 PBC 4 680x512px.tif|Granuloma in portal triad (Row 1 Right 400X).]] | |||
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[[File:3 PBC 4 680x512px.tif|Florid duct lesion (Row 2 Left 400X).]] | |||
[[File:4 PBC 4 680x512px.tif|Triad missing interlobular bile duct (Row 2 Right 400X).]] | |||
|} | |||
Primary biliary cirrhosis. Inflamed triads [arrows] amid undisturbed hepatocytes (Row 1 Left 40X). Granuloma in portal triad (Row 1 Right 400X). Florid duct lesion (Row 2 Left 400X). Triad missing interlobular bile duct (Row 2 Right 400X). | |||
{| | {| | ||
[[File:1 PBC 3 680x512px.tif| Ill defined triads, inflamed lobule (40X).]] | [[File:1 PBC 3 680x512px.tif| Ill defined triads, inflamed lobule (40X).]] | ||
[[File:2 PBC 3 680x512px.tif| Triad without a bile duct. Macrophages & occasional lymphocytes without epithelioid cells needed for granuloma and space where bile duct likely once was [cyan arrowhead] (400X).]] | [[File:2 PBC 3 680x512px.tif| Triad without a bile duct. Macrophages & occasional lymphocytes without epithelioid cells needed for granuloma and space where bile duct likely once was [cyan arrowhead] (400X).]] | ||
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[[File:3 PBC 3 680x512px.tif| PAS without diastase shows triad lacking bile duct and piecemeal necrosis (200X).]] | [[File:3 PBC 3 680x512px.tif| PAS without diastase shows triad lacking bile duct and piecemeal necrosis (200X).]] | ||
[[File:4 PBC 3 680x512px.tif| PAS with diastase shows bile duct/proliferating bile ductules with epithelial injury and hepatocytes with ballooning degeneration (400X).]] | |||
<br> | <br> | ||
[[File:5 PBC 3 680x512px.tif| Trichrome shows space of Disse collagenization and periportal fibrosis without definite bridging (100X)..]] | [[File:5 PBC 3 680x512px.tif| Trichrome shows space of Disse collagenization and periportal fibrosis without definite bridging (100X)..]] | ||
[[File:6 PBC 3 680x512px.tif| Iron stain shows isolated focus of hepatocytes with cytoplasmic blue granules (200X)]] | [[File:6 PBC 3 680x512px.tif| Iron stain shows isolated focus of hepatocytes with cytoplasmic blue granules (200X)]] | ||
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Primary biliary cirrhosis. AMA positive. Viral serology/ANA negative. No definite granulomas. Ill defined triads, inflamed lobule ( | Primary biliary cirrhosis. AMA positive. Viral serology/ANA negative. No definite granulomas. Ill defined triads, inflamed lobule (Row 1 Left 40X). Triad without a bile duct. Macrophages & occasional lymphocytes without epithelioid cells needed for granuloma and space where bile duct likely once was [cyan arrowhead] (Row 1 Right 400X). PAS without diastase shows triad lacking bile duct and piecemeal necrosis (Row 2 Left 200X). PAS with diastase shows bile duct/proliferating bile ductules with epithelial injury and hepatocytes with ballooning degeneration (Row 2 Right 400X). Trichrome shows space of Disse collagenization and periportal fibrosis without definite bridging (Row 3 Left 100X). Iron stain shows isolated focus of hepatocytes with cytoplasmic blue granules (Row 3 Right 200X). | ||
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[[File:4 PBC 2 680x512px.tif|Trichrome of the same triad shows portal fibrosis (200X).]] | [[File:4 PBC 2 680x512px.tif|Trichrome of the same triad shows portal fibrosis (200X).]] | ||
|} | |} | ||
Primary biliary cirrhosis. Two inflamed triads accompany acini with mild steatosis ( | Primary biliary cirrhosis. Two inflamed triads accompany acini with mild steatosis (Row 1 Left 20X). A triad bears a poorly formed granuloma [yellow arrowhead]. A bile duct is also seen [red arrowhead] (Row 1 Right 200X). A triad lacks a bile duct (Row 2 Left 200X). Trichrome of the same triad shows portal fibrosis (Row 2 Right 200X). | ||
A triad bears a poorly formed granuloma [yellow arrowhead]. A bile duct is also seen [red arrowhead] ( | |||
{| | {| | ||
[[File:1 PBC - 1 - 40X 680x512px.tif|Acini & lobules distorted by inflammation]] | [[File:1 PBC - 1 - 40X 680x512px.tif|Acini & lobules distorted by inflammation]] | ||
[[File:2 PBC - 1 - 200X 680x512px.tif|Loose granuloma in triad without duct]] | [[File:2 PBC - 1 - 200X 680x512px.tif|Loose granuloma in triad without duct]] | ||
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[[File:3 PBC - 1 - 200X 680x512px.tif|Well-formed granuloma]] | [[File:3 PBC - 1 - 200X 680x512px.tif|Well-formed granuloma]] | ||
[[File:4 PBC - 1 -200X 680x512px.tif|Piecemeal necrosis, PAS without diastase]] | |||
<br> | <br> | ||
[[File:5 PBC - 1 -400X 680x512px.tif|Damaged bile duct, PAS with diastase]] | [[File:5 PBC - 1 -400X 680x512px.tif|Damaged bile duct, PAS with diastase]] | ||
[[File:6 PBC - 1 -200X 680x512px.tif|Bridging fibrosis, trichrome]] | [[File:6 PBC - 1 -200X 680x512px.tif|Bridging fibrosis, trichrome]] | ||
|} | |} | ||
Primary biliary cirrhosis with bridging fibrosis. Acini & lobules distorted by inflammation ( | Primary biliary cirrhosis with bridging fibrosis. Acini & lobules distorted by inflammation (Row 1 Left 40X) Loose granuloma in triad without duct (Row 1 Right 200X) Well-formed granuloma (Row 2 Left 200X) Piecemeal necrosis, PAS without diastase (Row 2 Right 200X) Damaged bile duct, PAS with diastase (Row 3 Left 400X) Bridging fibrosis, trichrome (Row 3 Right,200X) | ||
===Staging PBC=== | ===Staging PBC=== | ||