Liver Biopsies: Anatomy and Histological Considerations (Online Course)

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Author: Brooke Eguia, BS, MS, HT(ASCP), HTL(ASCP)
Reviewer: Diana Harrington, BS, HT(ASCP)

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Continuing Education Credits


  • Identify tissue and cellular components of a liver biopsy.
  • Describe characteristic histologic features observed in liver biopsies with common liver diseases.
  • Define common special stain applications performed on liver biopsies and list the diseases that the stains assist in identifying.
  • Explain critical factors that contribute to optimal technical preparation of liver biopsies.
  • Identify different pigments that can be seen in liver biopsies.

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Course Outline

  • Introduction
      • Introduction
  • Tissue Identification
      • Connective Tissue
      • Connective Tissue: Type I Collagen
      • Connective Tissue: Type III Collagen
      • Hepatocytes: Liver Epithelial Cells
      • Kupffer Cells and other Sinusoidal Cells
      • Type III collagen or reticular connective tissue provides architectural framework found in the form of a honeycomb network within the liver.
  • Normal Histology
      • Lobular Organization: Portal Tracts and Central Veins
      • Portal Tracts: Bile Ducts
      • Portal Tracts: Arterioles
      • Portal Tracts: Portal Vein
      • Parenchyma: The "Lobule"
      • Parenchyma: Sinusoids
      • The portal vein provides a large percentage of the blood supply to the liver; the remaining blood is supplied to the liver via the hepatic artery.
      • The epithelial cells of the liver are grouped together to form functional units referred to as liver lobules.
  • Technical Preparation
      • Fixative
      • Rapid Tissue Processing: Transplant Patients
      • Biopsy Cycle Tissue Processing
      • Cassetting: Sponge versus Wrapping
      • Liver biopsies are delicate and subject to grossing artifacts. Using sponges to secure biopsy tissue in a tissue cassette has been proven to cause com...
  • Microtomy
      • Artifacts
      • Section Thickness
      • Step Sections
      • To aid in diagnosis, it is recommended that liver biopsy samples are sectioned at what micrometer (μm) thickness?
  • Disease
      • Benign Inflammatory Metabolic Disease
      • Benign Inflammatory Metabolic Disease: Non-Alcoholic Steatohepatitis (NASH)
      • Benign Inflammatory Metabolic Disease: Hemochromotosis and Hemosiderosis
      • As hereditary hemochromatosis and hemosiderosis progress, it becomes LESS difficult for the pathologist to make the distinction between these diseases...
      • Benign Inflammatory Metabolic Disease: Wilson's Disease
      • Benign Inflammatory Metabolic Disease: Amyloidosis
      • Amyloid is a protein that is found in the form of a beta-pleated sheet. An accumulation of these proteins in organs and/or tissues is known as this.
      • Hepatitis: Alcoholic Liver Disease
      • Hepatitis: Viral A, B, and C
      • Hepatitis B Core Antigen (HBcAg) and Hepatitis B Surface Antigen (HBsAg) Double Stain in Liver.
      • Hepatitis: Other Common Viruses
      • Mild and early onset alcoholic liver disease will demonstrate fatty changes that are reversible if alcohol consumption is discontinued.
      • Granulomatous Hepatitis
      • Granulomatous Hepatitis: Fungal Infections
      • Hepatitis: Drug Induced
      • Transplant Induced: Rejection
      • Transplant Induced: Graft Versus Host Disease (GVHD)
      • Advanced and End Stage Liver Disease (Cirrhosis)
      • Grocott's methenamine silver (GMS), periodic acid-Schiff (PAS), and hematoxylin and eosin (H&E) stains may be used to identify which of the follow...
      • Tumors: Benign
      • Tumors: Malignant
      • Malignant Tumors: Metastatic
      • Malignant Tumors: Primary
  • Stains
      • Trichrome
      • Reticulin
      • Rhodanine
      • Prussian Blue
      • Immunohistochemistry (IHC) and Immunoperoxidase (IP)
      • Masson's trichrome stain is used to demonstrate connective tissue in liver biopsies, staining collagen blue.
      • Reticular connective tissue cannot be visualized using the hematoxylin and eosin (H&E) stain. Which of the following is a silver stain used to ide...
  • Pigments
      • Exogenous Pigments
      • Endogenous Pigments
      • Which of the following is a yellow-brown, exogenous pigment found in increased amounts as cells age in organs such as nerves, heart, and liver?
      • Which of the following pigments are classified as endogenous? (Choose all that apply.)
  • References
      • References

Additional Information

Level of instruction: Basic to intermediate
Intended audience:  Clinical laboratory histotechnologists, histotechnicians, and other medical laboratory personnel who have an interest in this subject matter. This course is also appropriate for histology and clinical laboratory science students, pathology residents, and practicing pathologists.  
Author information: Brooke Eguia, BS, MS, HT(ASCP), HTL(ASCP) is the Pathology Technical Supervisor at Fairview Southdale Hospital in Edina, Minnesota. She graduated from St. Cloud State University with a Bachelor of Science degree in general biology and from Capella University with a Master of Science in Human Service with a specialization in Health Care Administration. During her time as an undergraduate, Brooke's interests and studies focused on histologic techniques and gross anatomic dissection. Her senior year, she co-authored for aquatic toxicology research that Aquaculture published in January 2009. Acting as a primary health career mentor to high school students, Brooke satisfied her desire for training and teaching histotechnicians and also worked as adjunct faculty at Rasmussen College, as a Medical Assistant laboratory techniques instructor. Most recently, she has focused on proctoring histology students in clinical/classroom progress and exam preparation.
Reviewer information: Diana Harrington, BS, HT(ASCP) is a histotechnologist at The Dermatology Center of Indiana. Since graduating from Indiana University, she has worked in various hospital laboratories as a medical technologist and histotechnologist. Her experience led her to teach IU students as a Clinical Education Supervisor and create the Histotechnology Program as Program Director for Keiser University in Florida.
Course description: The goal of this continuing education course is to provide essential knowledge to histology professionals regarding the structure and function of a liver biopsy received in the pathology laboratory. This course explores common diseases and provides information regarding how a liver biopsy assists the pathologist and clinician in diagnosing these diseases. Upon completion of this course, the histotechnologist will have a greater understanding of optimal histotechniques used to create slides that are adequate for diagnosis, develop a foundational knowledge about the anatomy of

Liver Biopsies: Anatomy and Histological Considerations Keywords

These are the most common topics and keywords covered in Liver Biopsies: Anatomy and Histological Considerations:

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A liver biopsy stained with Gordon & Sweets reticulin stain demonstrating normal reticulin architecture, 40X magnification.

A liver biopsy (trichrome stain) demonstrating an increase in type I collagen in a patient with bridging portal fibrosis.

A liver biopsy stained with Gordon & Sweets reticulin stain demonstrating abnormal, reticulin collapse as well as abnormal arrangement of hepatocytes.

A trichrome stained liver biopsy demonstrating normal tissue architecture and favorable tissue cassetting.

A liver biopsy stained with Prussian blue demonstrating ferric iron (+3) in a patient with hemosiderosis.

SD12-489 cirrhosis with copper (3)


H&E stained liver biopsy demonstrating hepatocellular carcinoma (HCC) architecture.