UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Interpretation of liver biopsy specimens

Author
Maria Isabel Fiel, MD, FAASLD
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

The histopathologic examination of the liver can provide otherwise unobtainable information regarding its structural integrity and the type and degree of injury and/or fibrosis that affect the liver [1-3]. It is also useful for monitoring the efficacy of treatment and permits the definitive diagnosis of tumors.

A liver biopsy is usually performed after a thorough, noninvasive clinical evaluation in patients with chronically (greater than six months) elevated liver biochemical tests. The pertinent clinical information should be made available to the pathologist so that the histopathological findings can be interpreted in the appropriate clinical context [1-3]. (See "Approach to the patient with abnormal liver biochemical and function tests".)

This topic review will focus on the interpretation of liver biopsy specimens. The examples presented show typical histologic features of each disease entity. Methods to obtain a liver biopsy and histologic scoring systems for chronic liver disease are described elsewhere. (See "Percutaneous, fine-needle aspiration, and laparoscopic liver biopsy" and "Transjugular liver biopsy" and "Histologic scoring systems for chronic liver disease".)

SEGMENTAL ANATOMY

The liver can be divided into right and left lobes, each of which has its own blood supply. The right lobe comprises 50 to 70 percent of the liver mass (figure 1). The liver can be further subdivided into eight segments based upon the segmental hepatic arterial supply and distribution.

LOBULE AND ACINAR MODELS

Two conceptual models have been proposed relating to the architecture of the hepatic parenchyma. Terminal portal veins and hepatic venules interdigitate between sinusoids. The "lobule" model considers the terminal hepatic venules, which are also known as the central vein/venules, to be the center of the hepatic microcirculation. Thus, this area is known as the centrilobular zone, whereas in the "acinar" model (also known as the Rappaport classification) is considered to represent the periphery of the acinus (figure 2).

                                                              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Apr 01 00:00:00 GMT+00:00 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
Topic Outline

GRAPHICS