Here is a different patient's liver.

How is the location of the inflammatory response different?

What is the yellow-brown pigment you see?

What is different about the bile duct epithelium?

What might cause this distribution of inflammation?

Assuming the cause of the inflammation in these patients resolves, what do you think their liver histology will look like?

This patient has predominantly periportal inflammation (PMNs and lymphocytes). This is an example of biliary obstruction (e.g. by a gallstone in the common duct). The obstruction causes a backup of bile in the liver (the yellow-brown pigment). In addition, the obstructed ducts permit the growth of trapped gut bacteria resulting in an ascending cholangitis, eliciting an inflammatory response around the bile ducts. As you can see, the inflammatory response induces "reactive atypia" in the bile duct epithelium, making the cells appear large with hyperchromatic nuclei. Reactive atypia can occur with any epithelium (e.g. intestinal, breast, esophagus, cervical, salivary glands) and can be mistaken for carcinoma (arguably the worst mistake a pathologist can make)!

Because of the regenerative capacity of the liver, it is possible that both of these patients will resolve with no scarring; however, with chronic injury they may progress to fibrosis and cirrhosis.