The normal adult human liver biopsy: A quantitative reference standard

In assessing adult human liver histology, questions remain concerning the normal number of portal tracts and bile ducts in a liver biopsy. We therefore reviewed liver biopsies obtained with use of a percutaneous Menghini cutting needle (14G, internal diameter 1.6 mm), from 16 patients undergoing liver biopsy for screening procedures (age 49 ± 14 years, ±SD) and found to be normal by histological examination. The average aggregate length of the liver tissue was 1.8 ± 0.8 cm (area of 16.4 ± 10.7 mm2), representing 7 ± 3 tissue fragments. Portal triads containing at least one profile each of a portal vein, hepatic artery, and interlobular bile duct numbered 11 ± 6 per biopsy (range 3‐23). Portal dyads, which did not contain one of these profiles, usually the portal vein, numbered 8 ± 5 (range 1‐18). On a per‐specimen basis, 38% of portal tracts did not contain a portal vein, 7% did not contain a bile duct, and 9% did not contain a hepatic artery. Because of multiplicity of profiles within portal tracts, however, the average number of profiles per portal tract was 6 ± 5 (range 2‐35). Notably, on average there were 2.3 ± 2.2 interlobular bile ducts per portal tract, compared to 2.6 ± 2.3 hepatic arteries and 0.7 ± 0.7 portal veins. The average minimum external diameter of interlobular bile ducts was 13 ± 4 μm, of hepatic arteries 12 ± 5 μm, and of portal veins 35 ± 25 μm. Bile ducts greater than 30 μm in diameter were rare, only one each in two biopsies were observed. In contrast, probable canals of Hering were occasionally evident at the periphery of portal tracts (6 ± 6 per biopsy) and within the lobular parenchyma as strings of cuboidal cells (5 ± 5 per biopsy). We conclude that, although multiplicity of profiles is normal, portal dyads are almost as common as portal triads in normal peripheral liver tissue. On average, there are two interlobular bile ducts, two hepatic arteries, and one portal vein per portal tract, with 6 full portal triads per linear cm of tissue obtained by external Menghini biopsy technique with use of a 14G needle, equivalent to 0.8 ± 0.5 portal triads per mm2. By serving as a reference standard for adult human liver histology, these findings may assist in the histopathological assessment of liver biopsies, particularly those performed for disease conditions featuring loss of intrahepatic bile ducts.

[1]  G. Menghini.  One-second needle biopsy of the liver. , 1958, Gastroenterology.

[2]  R. Bahn,et al.  THE PATHOLOGY OF PRIMARY BILIARY CIRRHOSIS WITH EMPHASIS ON HISTOGENESIS. , 1964, American journal of clinical pathology.

[3]  E. Ritman,et al.  Anatomy of the human biliary system studied by quantitative computer‐aided three‐dimensional imaging techniques , 1998, Hepatology.

[4]  H. Popper,et al.  PROLIFERATION OF BILE DUCTS IN CIRRHOSIS. , 1964, Archives of pathology.

[5]  Hans Rudolf Gnägi,et al.  CORRELATED MORPHOMETRIC AND BIOCHEMICAL STUDIES ON THE LIVER CELL , 1969, The Journal of cell biology.

[6]  K. Wake,et al.  Liver units in three dimensions: I. Organization of argyrophilic connective tissue skeleton in porcine liver with particular reference to the "compound hepatic lobule". , 1991, The American journal of anatomy.

[7]  Y. Nakanuma,et al.  Histometric and serial section observations of the intrahepatic bile ducts in primary biliary cirrhosis , 1979 .

[8]  J. Williams,et al.  Morphometric inflammatory cell analysis of human liver allograft biopsies. , 1991, Transplantation.

[9]  K. Batts,et al.  Chronic liver allograft rejection: a National Institute of Diabetes and Digestive and Kidney Diseases interinstitutional study analyzing the reliability of current criteria and proposal of an expanded definition. National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation , 1998, The American journal of surgical pathology.

[10]  A. Rappaport.  The microcirculatory acinar concept of normal and pathological hepatic structure. , 1976, Beitrage zur Pathologie.

[11]  M. Gerber,et al.  Development of intrahepatic bile ducts in humans. Immunohistochemical study using monoclonal cytokeratin antibodies. , 1989, Archives of pathology & laboratory medicine.

[12]  T. B. Magath.  The Erythrocyte Sedimentation Test , 1933 .

[13]  Z. Borowy,et al.  Subdivision of hexagonal liver lobules into a structural and functional unit. Role in hepatic physiology and pathology , 1954, The Anatomical record.

[14]  H. Popper,et al.  Electron microscopic studies of normal and proliferated bile ductules. , 1961, The American journal of pathology.

[15]  G. Landini,et al.  Fractal geometry in rat chimeras demonstrates that a repetitive cell division program may generate liver parenchyma. , 1994, Developmental biology.

[16]  D. Snover,et al.  Hepatic Graft Versus Host Disease: A Study of the Predictive Value of Liver Biopsy in Diagnosis , 1984, Hepatology.

[17]  A. Moreno,et al.  Idiopathic biliary ductopenia in adults without symptoms of liver disease. , 1997, The New England journal of medicine.

[18]  Randall G. Lee,et al.  Banff schema for grading liver allograft rejection: An international consensus document , 1997, Hepatology.

[19]  N. LaRusso,et al.  Morphological, molecular, and functional heterogeneity of cholangiocytes from normal rat liver. , 1996, Gastroenterology.

[20]  A Moragas,et al.  Mathematical morphologic analysis of liver cirrhosis. Correlation with etiology, clinical score and hepatocellular carcinoma. , 1992, Analytical and quantitative cytology and histology.

[21]  R. Wiesner,et al.  Idiopathic adulthood ductopenia. A cause of chronic cholestatic liver disease and biliary cirrhosis. , 1988, Journal of hepatology.

[22]  Y. Nakanuma,et al.  Microstructure and development of the normal and pathologic biliary tract in humans, including blood supply , 1997, Microscopy research and technique.

[23]  K. Washington,et al.  Peribiliary vascular plexus in primary sclerosing cholangitis and primary biliary cirrhosis. , 1997, Human pathology.

[24]  E. Lalani,et al.  Reactive biliary epithelium: the product of a pluripotential stem cell compartment? , 1996, Human pathology.