Pathology: Cirrhosis

     Liver fibrosis is the wound healing pathway of chronic liver disease.  It is a dynamic process of scar tissue deposition and removal.  However, with ongoing insult to the liver the result is often stage IV liver fibrosis, or cirrhosis.

It is important to recognize the histologic hallmarks of cirrhosis on liver biopsy.  It is easiest to visualize on a trichrome stain, where scar tissue appears as a blue, fibrous band, in contrast to the pink color of the hepatocytes.  The fibrosis extends from one portal triad to the next (as in hepatitis C virus infection), eventually forming discrete nodules and a distorted architecture.

In this biopsy, notice the thick blue band of fibrosis forming a discrete nodule.  The thickness of this particular scar tissue is enough that reversal of cirrhosis is unlikely to occur even if the underlying liver disease is removed.

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