A 45-year-old woman with primary biliary cholangitis (PBC) has elevated ALP, antimitochondrial antibodies (AMA), and pruritis. The bile duct lesion characteristic of PBC is:

• A Fibro-obliterative cholangitis affecting large intrahepatic and extrahepatic ducts
• B Periductal fibrosis in an 'onion-skin' pattern around medium-sized ducts
• C Florid duct lesion — granulomatous destruction of small interlobular bile ducts ✓
• D Bile ductular proliferation with neutrophilic pericholangitis

Explanation

PBC targets small interlobular bile ducts; the pathognomonic 'florid duct lesion' shows granulomatous inflammation with lymphocyte and plasma cell infiltration destroying the epithelium of small bile ducts. AMA (anti-PDC-E2) are the serological hallmark. Primary sclerosing cholangitis (PSC) shows fibro-obliterative cholangitis of large ducts with 'onion-skin' periductal fibrosis on imaging and biopsy.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.