A 50-year-old woman with primary biliary cholangitis (PBC) has elevated ALP, pruritus, and jaundice. The characteristic histological lesion in early PBC is:

• A Piecemeal necrosis at the portal-parenchymal interface
• B Concentric periductal 'onion-skin' fibrosis around large bile ducts
• C Florid duct lesion: granulomatous destruction of interlobular bile ducts ✓
• D Plasma cell-rich portal infiltrate with rosette formation

Explanation

The hallmark early lesion of PBC is the 'florid duct lesion'—granulomatous destruction of small interlobular bile ducts with lymphocytic and granulomatous infiltration. Over time, bile duct loss leads to chronic cholestasis and biliary cirrhosis. AMA (anti-mitochondrial antibodies) are positive in >90% of PBC. Piecemeal necrosis characterizes chronic hepatitis (interface hepatitis); onion-skin fibrosis around large ducts is characteristic of primary sclerosing cholangitis (PSC); plasma cell rosettes are seen in autoimmune hepatitis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.