Liver Pathology Update

The concept of hepatic artery-bile duct parallelism in the diagnosis of ductopenia in liver biopsy samples.
Moreira RK, Chopp W, Washington MK. Am J Surg Pathol. 2011 Mar;35(3):392-403. (CUMC Full Text PDF)

In this paper, my colleagues and I essentially apply the concept of hepatic artery-bile duct parallelism (i.e. parallel arrangement of these two structures within portal tracts) to propose specific diagnostic criteria for the diagnosis of bile duct loss (ductopenia) in liver biopsy samples. The final set of proposed criteria is relatively simple: two or more portal tracts containing an unpaired hepatic artery (representing at least 10% of all portal tracts in a given sample) is indicative of bile duct loss. The article is definitely information-heavy and may best be appreciated with a couple of glasses of fine wine.

 This liver biopsy from a patient with stage 1 PBC illustrates the application of the "unpaired hepatic artery" method for evaluation of ductopenia (click on image to enlarge). A total of seven portal tracts are present in the sample below, five of which contain an interlobular bile duct (BD+). Therefore, the speciment is not diagnostic for bile duct loss. However, two of seven portal tracts contain an unpaired hepatic artery (UHA+), which is indicative of bile duct loss according to the data presented in this study.