A 50-year-old woman with primary biliary cholangitis (PBC) has elevated ALP and positive anti-mitochondrial antibody (AMA) at 1:640. A liver biopsy is performed before starting ursodeoxycholic acid. Which histological lesion is the hallmark of PBC on biopsy?
- A Interface hepatitis with plasma cell infiltration
- B Periportal copper deposition with Mallory-Denk bodies
- C Florid duct lesion (granulomatous destruction of interlobular bile ducts) ✓
- D Bridging fibrosis with macronodular regeneration
Correct answer: C. Florid duct lesion (granulomatous destruction of interlobular bile ducts)
Explanation
The florid duct lesion, characterized by granulomatous inflammation and destruction of interlobular bile ducts, is the hallmark of early-stage PBC. Interface hepatitis with plasma cells is typical of autoimmune hepatitis. Mallory-Denk bodies are seen in steatohepatitis (alcoholic and non-alcoholic). Macronodular regeneration is a feature of established cirrhosis, not a diagnostic hallmark. AMA positivity plus florid duct lesions confirm PBC.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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