Primary biliary cirrhosis evolves through a series of histologic changes before finally reaching the cirrhotic state. Several authors have classified these changes into stages.
Histologic Features
Stage
lymphocytic, nonsuppurative cholangitis; portal hepatitis; periportal change absent or minimal
1
ductular destruction (with ductopenia) and proliferation; periportal hepatitis with fibrosis
2
bridging necrosis and/or fibrosis with formation of fibrous septa
3
cirrhosis with regenerative nodules
4
where:
• Cholangitis and ductular proliferation may be reduced or absent in Stages 3 and 4 because of ductopenia and scarring.
Limitations:
• The pathologic changes are not evenly distributed within the liver. Therefore a stage determined on a limited sampling such as needle biopsy may differ from that seen with a more extensive sampling.
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