How does cirrhosis appear histologically?

How does cirrhosis appear histologically?

• A. Diffuse fibrosis without nodularity.
• B. Normal lobular architecture with mild inflammation.
• C. Hyperplasia of cholangiocytes.
• D. Nodular regenerative architecture with fibrous septa bridging nodules; loss of normal lobular architecture.

Answer: (D)

The histology of cirrhosis is defined by architectural disruption with regenerative nodules and bridging fibrous septa. Chronic liver injury leads to hepatocyte death and activation of fibrogenic pathways, causing excessive collagen deposition that forms fibrous bands connecting portal tracts and central veins. These bands split the liver into nodules of regenerating hepatocytes, resulting in a loss of the normal lobular architecture. That combination—nodular regenerative architecture with fibrous septa and disrupted lobular structure—is the hallmark of cirrhosis. Other patterns don’t fit cirrhosis: diffuse fibrosis without nodularity lacks the regenerative nodules; normal lobular architecture with only mild inflammation isn’t cirrhosis; and hyperplasia of cholangiocytes points to biliary disease rather than cirrhosis.

The histology of cirrhosis is defined by architectural disruption with regenerative nodules and bridging fibrous septa. Chronic liver injury leads to hepatocyte death and activation of fibrogenic pathways, causing excessive collagen deposition that forms fibrous bands connecting portal tracts and central veins. These bands split the liver into nodules of regenerating hepatocytes, resulting in a loss of the normal lobular architecture. That combination—nodular regenerative architecture with fibrous septa and disrupted lobular structure—is the hallmark of cirrhosis.

Other patterns don’t fit cirrhosis: diffuse fibrosis without nodularity lacks the regenerative nodules; normal lobular architecture with only mild inflammation isn’t cirrhosis; and hyperplasia of cholangiocytes points to biliary disease rather than cirrhosis.