In primary biliary cholangitis (PBC), the liver biopsy shows florid duct lesion — granulomatous destruction of interlobular bile ducts. The stage 4 histological finding is:

• A Florid granulomatous bile duct destruction limited to portal tracts
• B Established cirrhosis with regenerative nodules and bile duct loss (ductopenia in >50% of portal tracts) ✓
• C Periportal fibrosis with interface hepatitis only
• D Copper accumulation without fibrosis in zone 1

Explanation

PBC is histologically staged in 4 stages (Ludwig staging): Stage 1 — florid duct lesion (portal stage); Stage 2 — periportal hepatitis with ductular proliferation (periportal stage); Stage 3 — bridging fibrosis; Stage 4 — cirrhosis with established regenerative nodules and ductopenia (loss of bile ducts in >50% of portal tracts). Stage 4 cirrhosis with copper accumulation in periportal hepatocytes results from cholestasis impairing copper excretion, but this is secondary to the advanced stage.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.