Findings on histology:
(1) The majority of the portal tracts in a specimen appear to lack a bile duct. If 20 portal tracts are examined, the presence of >= 10 portal tracks without a bile duct indicates ductopenia.
(2) Interlobular and septal arteries tend to run with an hepatic artery branch. The ratio of the bile duct lumen to that of the artery is fairly constant at 70-80% (page 1327, Nakanuma), and 70-80% of arteries are accompanied by a bile duct (page 1330, Nakanuma). If more than 1 bile duct is present in a portal tract, then it is paired with the appropriately sized artery branch. The presence of < 70% of arterial branches without an associated bile duct suggests ductopenia.
Biliary ductules (found in the vicinity of the limiting plate) should not be counted. These may proliferate in conditions associated with ductopenia.
Ductopenia is a feature seen with destructive cholangitis and may occur in many conditions including:
(1) infections associated with AIDS (CMV, cryptosporidiosis, microsporidiosis, etc.)
(2) alcoholic hepatitis
(3) autoimmune cholangitis
(4) primary biliary cirrhosis
(5) graft-vs-host disease
(6) transplant rejection
(7) primary sclerosing cholangitis
(8) viral or autoimmune hepatitis
