Histopathology of chronic cholestasis and adult ductopenic syndrome.

This article reviews the histopathologic liver alterations in chronic cholestatic diseases and parenchymal changes associated with periportal ductular reaction and fibrosis, which may result in end-stage biliary cirrhosis. Adult ductopenic diseases are possible causes of such chronic cholestasis. Ductopenia is defined, and guidelines are given for its quantitation. The last section summarizes the specific histologic lesions of primary biliary cirrhosis, primary sclerosing cholangitis, their histologic mimics, and the differential diagnosis with drug-induced cholestasis and ductopenia.