Which histologic feature is classically seen in primary sclerosing cholangitis?

Which histologic feature is classically seen in primary sclerosing cholangitis?

• A. Onion-skin periductal fibrosis around bile ducts with bile duct proliferation and cholestasis
• B. Fatty change with cholestasis
• C. Granulomatous inflammation around the ducts
• D. Ductal dilation without inflammation

Answer: (A)

Primary sclerosing cholangitis is best recognized histologically by concentric, onion-skin periductal fibrosis around the bile ducts, often with ductular proliferation and accompanying cholestasis. This pattern reflects ongoing inflammatory injury that progressively fibroses the ducts, narrowing and eventually obstructing them. Other patterns don’t fit PSC as well. Fatty change with cholestasis is a generic liver injury pattern and not specific to PSC. Granulomatous inflammation around ducts is more typical of primary biliary cholangitis, which characteristically shows granulomas and destruction of small intrahepatic ducts. Ductal dilation without inflammation would not capture the chronic fibrosing process that characterizes PSC.

Primary sclerosing cholangitis is best recognized histologically by concentric, onion-skin periductal fibrosis around the bile ducts, often with ductular proliferation and accompanying cholestasis. This pattern reflects ongoing inflammatory injury that progressively fibroses the ducts, narrowing and eventually obstructing them.

Other patterns don’t fit PSC as well. Fatty change with cholestasis is a generic liver injury pattern and not specific to PSC. Granulomatous inflammation around ducts is more typical of primary biliary cholangitis, which characteristically shows granulomas and destruction of small intrahepatic ducts. Ductal dilation without inflammation would not capture the chronic fibrosing process that characterizes PSC.