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Bile duct changes in different etiologic types of end-stage chronic liver disease: a study on native explant livers
  1. Deepali Jain,
  2. Nabeen C Nayak
  1. Department of Pathology, Sir Ganga Ram Hospital, New Delhi, India
  1. Correspondence to Dr Deepali Jain, Department of Pathology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India; deepalijain76{at}


Aims Bile duct changes in the form of intraepithelial neoplasia or dysplasia have been well studied in chronic biliary tract diseases. It is important to analyse the morphologic spectrum of bile duct changes in non-biliary diseases as a link has been reported between intrahepatic cholangiocarcinoma and chronic liver disease associated with viral hepatitis, metabolic syndromes and with alcohol abuse.

Methods The authors retrospectively reviewed liver explants of alcoholic liver disease (ALD)-, hepatitis C virus- and non-alcoholic fatty liver disease-related end-stage liver diseases to analyse morphologic changes in large intrahepatic bile ducts. Diagnostic criteria of biliary intraepithelial lesions at end-stage disease are discussed.

Results Majority of explants exhibited reactive changes. Normal cuboidal epithelium of septal bile ducts was observed in minority of cases. Low-grade biliary intraepithelial neoplastic lesions were identified in all cases with variable frequency. None of the cases were associated with cholangiocarcinoma. Nuclear hyperchromasia, cellular polarity and presence o inflammation were considered as differentiating points between reactive and neoplastic lesions.

Conclusions At end stage of liver disease, large septal bile ducts rarely show normal morphology. Presence of low-grade biliary dysplasia at end stage signifies its frequent occurrence probably in response to alcohol/viral/metabolic syndrome-related injury.

Addition to literature Observational analysis of large bile ducts in non-biliary diseases of varied aetiology has not been discussed from this part of world where incidence of cholangiocarcinoma is low. Identifying these lesions correctly is important. The frequency of these lesions is not uncommon especially at the end-stage liver disease.

  • BilIN
  • reactive proliferation
  • bile ducts
  • end-stage liver disease
  • non-biliary
  • histopathology
  • ocular pathology
  • liver cancer
  • liver disease

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.