A 43-year-old man has experienced progressive fatigue, pruritus, and icterus for 4 months. A colectomy was performed 5 years ago for the treatment of ulcerative colitis. On physical examination, he now has generalized jaundice. The abdomen is not distended; on palpation, there is no abdominal pain and there are no masses. Laboratory studies show a serum alkaline phosphatase level of 285 U/L and an elevated titer of anti-neutrophil cytoplasmic antibodies. Cholangiography shows widespread intrahepatic biliary tree obliteration and a beaded appearance in the remaining ducts. Which of the following morphologic features is most likely to be present in his liver?
The major targets in primary sclerosing cholangitis are intrahepatic bile ducts, and ulcerative colitis coexists in 70% of cases. Ducts undergo destructive cholangitis that leads eventually to periductal fibrosis and cholestatic jaundice. Eventually, cirrhosis and liver failure can occur. The copper deposition is characteristic of Wilson disease, which is associated with chronic hepatitis and cirrhosis. Granulomatous bile duct destruction occurs in primary biliary cirrhosis. Interface hepatitis is characteristic of chronic active viral hepatitis. a1 -Antitrypsin deficiency with PAS-positive periportal globules is associated with cirrhosis. Portal bridging fibrosis with nodular regeneration defines cirrhosis.
Concentric "onion-skin" ductular fibrosis
Copper deposition in hepatocytes
Granulomatous bile duct destruction
Interface hepatitis
Liver & Biliary Tract