Qualitative and quantitative differences between bile ducts in chronic hepatitis and in primary biliary cirrhosis

C A Rubio¹

¹ Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology, Karolinska Institute, 171 76 Stockholm, Sweden

Correspondence to:
Dr Rubio Carlos.Rubio{at}onkpat.ki.se

Aim—Lymphocytic infiltration in the portal triads usually conceals the detection—in haematoxylin and eosin (H&E) stained sections—of bile ducts in two liver diseases: chronic hepatitis and primary biliary cirrhosis. The aim was to assess the number and the characteristics of the bile ducts in those diseases with the aid of an antibody to cytokeratin 7 (CK7)

Methods—Consecutive sections from 99 liver biopsies were stained with H&E and anti-CK7.

Results—In H&E sections the total number of central bile ducts in the triads was 52 in primary biliary cirrhosis (n = 37), 69 in chronic hepatitis (n = 43), and 30 in miscellaneous cases (n = 19). Using anti-CK7, the number of central bile ducts was 276 in primary biliary cirrhosis, 348 in chronic hepatitis, and 96 in miscellaneous cases. Central bile ducts with lumen were found in 93.0% of chronic hepatitis cases and in 89.5% of the miscellaneous cases, but in only 13.5% of the primary biliary cirrhosis cases. Peripheral bile ducts in groups of 4/triad were found in all cases of chronic hepatitis (100%) and in 75.7% primary biliary cirrhosis cases, but only in 10.5% of the miscellaneous cases. In 21.6% of primary biliary cirrhosis cases, no bile ducts (central and/or peripheral) were present.

Conclusions—Anti-CK7 detects bile ducts in the triads that are concealed by chronic inflammatory cells. Central and peripheral bile ducts in groups of 4 were significantly more common in primary biliary cirrhosis and chronic hepatitis than in other liver diseases. The lack of lumen in central bile ducts, as well as the absence of central and/or peripheral bile ducts in CK7 stained liver sections, seem to be valuable additional parameters in the differential diagnosis between primary biliary cirrhosis and chronic hepatitis.

Key Words: bile ducts • cytokeratin 7 • primary biliary cirrhosis

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