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Difference between revisions of "Primary biliary cholangitis"
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→Images: added a case without definite granulomas
(→Microscopic: a second PBC case, this one much more typically hard to diagnose!) |
(→Images: added a case without definite granulomas) |
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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 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:3 PBC 3 680x512px.tif| PAS without diastase shows triad lacking bile duct and piecemeal necrosis (200X).]] | |||
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[[File:4 PBC 3 680x512px.tif| PAS with diastase shows bile duct/proliferating bile ductules with epithelial injury and hepatocytes with ballooning degeneration (400X).]] | |||
[[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)]] | |||
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Primary biliary cirrhosis. AMA positive. Viral serology/ANA negative. No definite granulomas. Ill defined triads, inflamed lobule (TL 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] (TM 400X). PAS without diastase shows triad lacking bile duct and piecemeal necrosis (TR 200X). PAS with diastase shows bile duct/proliferating bile ductules with epithelial injury and hepatocytes with ballooning degeneration (BL 400X). Trichrome shows space of Disse collagenization and periportal fibrosis without definite bridging (BM 100X). Iron stain shows isolated focus of hepatocytes with cytoplasmic blue granules (BR 200X). | |||
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[[File:1 PBC 2 680x512px.tif|Two inflamed triads accompany acini with mild steatosis (20X).]] | [[File:1 PBC 2 680x512px.tif|Two inflamed triads accompany acini with mild steatosis (20X).]] | ||
[[File:2 PBC 2 680x512px.tif|A triad bears a poorly formed granuloma [yellow arrowhead]. A bile duct is also seen [red arrowhead] (200X).]] | [[File:2 PBC 2 680x512px.tif|A triad bears a poorly formed granuloma [yellow arrowhead]. A bile duct is also seen [red arrowhead] (200X).]] | ||
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[[File:3 PBC 2 680x512px.tif|A triad lacks a bile duct (200X).]] | [[File:3 PBC 2 680x512px.tif|A triad lacks a bile duct (200X).]] | ||
[[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).]] | ||
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[[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]] | ||
[[File:3 PBC - 1 - 200X 680x512px.tif|Well-formed granuloma]] | [[File:3 PBC - 1 - 200X 680x512px.tif|Well-formed granuloma]] | ||
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[[File:4 PBC - 1 -200X 680x512px.tif|Piecemeal necrosis, PAS without diastase]] | [[File:4 PBC - 1 -200X 680x512px.tif|Piecemeal necrosis, PAS without diastase]] | ||
[[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]] | ||
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Primary biliary cirrhosis with bridging fibrosis. Acini & lobules distorted by inflammation (TL,40X) Loose granuloma in triad without duct (TM,200X) Well-formed granuloma (TR,200X) Piecemeal necrosis, PAS without diastase (BL,200X) Damaged bile duct, PAS with diastase (BM,400X) Bridging fibrosis, trichrome (BR,200X) | |||
Primary biliary cirrhosis with bridging fibrosis. Acini & lobules distorted by inflammation (TL,40X) Loose granuloma in triad without duct ( | |||
===Staging PBC=== | ===Staging PBC=== | ||