Liver Biopsies: Anatomy and Histological Considerations (Online CE Course)

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Author: Brooke Eguia, BS, MS, HT(ASCP), HTL(ASCP)
Reviewer: Kristen Meyer, HTL(ASCP)CM, QIHCCM

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The goal of this continuing education course is to provide essential knowledge to histology professionals regarding the structure and function of a liver biopsy received in the pathology laboratory. This course explores common diseases and provides information regarding how a liver biopsy assists the pathologist and clinician in diagnosing these diseases. Upon completion of this course, the histotechnologist will have a greater understanding of optimal histotechniques used to create slides that are adequate for diagnosis, develop a foundational knowledge about the anatomy of a liver biopsy (as well as common diseases), and also identify artifacts, special stains, and pigments that are specific to liver biopsies that may be used to assist in diagnosis.

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Continuing Education Credits

P.A.C.E.® Contact Hours (acceptable for AMT, ASCP, and state recertification): 1.5 hour(s)
Approved through 4/30/2024
Approved through 4/30/2024


  • Identify tissue and cellular components of a liver biopsy.
  • Describe characteristic histologic features observed in liver biopsies with common liver diseases.
  • Define common special stain applications performed on liver biopsies and list the diseases that the stains assist in identifying.
  • Explain critical factors that contribute to optimal technical preparation of liver biopsies.
  • Identify different pigments that can be seen in liver biopsies.

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Course Outline

Click on the links below to preview selected pages from this course.
  • Introduction
  • Tissue Identification
      • Connective Tissue
      • Connective Tissue: Type I Collagen
      • Connective Tissue: Type III Collagen
      • Hepatocytes: Liver Epithelial Cells
      • Kupffer Cells and Other Sinusoidal Cells
      • True or False: Type III collagen, or reticular connective tissue, provides an architectural framework found in the form of a honeycomb network within ...
  • Normal Histology
      • Lobular Organization: Portal Tracts and Central Veins
      • Portal Tracts: Bile Ducts
      • Portal Tracts: Arterioles
      • Portal Tracts: Portal Vein
      • Parenchyma: The "Lobule"
      • Parenchyma: Sinusoids
      • True or False: The portal vein provides a large percentage of the blood supply to the liver; the remaining blood is supplied to the liver via the hepa...
      • True or False: The epithelial cells of the liver are grouped together to form functional units referred to as liver lobules.
  • Technical Preparation
      • Fixative
      • Rapid Tissue Processing: Transplant Patients
      • Biopsy Cycle Tissue Processing
      • Cassetting: Sponge versus Wrapping
      • True or False: Liver biopsies are delicate and subject to grossing artifacts. Using sponges to secure biopsy tissue in a tissue cassette has been prov...
  • Microtomy
      • Artifacts
      • Section Thickness
      • Step Sections
      • To aid in diagnosis, it is recommended that liver biopsy samples are sectioned at what micrometer (μm) thickness?
  • Disease
      • Benign Inflammatory Metabolic Disease
      • Benign Inflammatory Metabolic Disease: Non-Alcoholic Steatohepatitis (NASH)
      • Benign Inflammatory Metabolic Disease: Hemochromatosis and Hemosiderosis
      • True or False: As hereditary hemochromatosis and hemosiderosis progress, it becomes less difficult for the pathologist to make the distinction between...
      • Benign Inflammatory Metabolic Disease: Wilson's Disease
      • Benign Inflammatory Metabolic Disease: Amyloidosis
      • Which of the following is found in increased levels in Wilson's disease and can be detected with rhodanine?
      • Alcoholic Liver Disease
      • Hepatitis: Viral A, B, and C
      • Hepatitis B Core Antigen (HBcAg) and Hepatitis B Surface Antigen (HBsAg) Double Stain in Liver.
      • Hepatitis: Other Common Viruses
      • True or False: Mild and early-onset alcoholic liver disease will demonstrate fatty changes that are reversible if alcohol consumption is discontinued.
      • Granulomatous Hepatitis
      • Granulomatous Hepatitis: Fungal Infections
      • Hepatitis: Drug Induced
      • Transplant Induced: Rejection
      • Transplant Induced: Graft Versus Host Disease (GVHD)
      • Advanced and End-Stage Liver Disease (Cirrhosis)
      • Grocott's methenamine silver (GMS), periodic acid-Schiff (PAS), and hematoxylin and eosin (H&E) stains may be used to identify all the following f...
      • Tumors: Benign
      • Tumors: Malignant
      • Malignant Tumors: Metastatic
      • Malignant Tumors: Primary
  • Stains
      • Trichrome
      • Reticulin
      • Rhodanine
      • Prussian Blue
      • Oil Red O
      • Immunohistochemistry and Immunoperoxidase
      • True or False: Masson's trichrome stain is used to demonstrate connective tissue in liver biopsies, staining collagen blue.
      • Reticular connective tissue cannot be visualized using the hematoxylin and eosin (H&E) stain. Which of the following is a silver stain used to ide...
  • Pigments
      • Exogenous Pigments
      • Endogenous Pigments
      • Which of the following is a yellow-brown, endogenous pigment found in increased amounts as cells age in organs such as nerves, heart, and liver?
      • Which of the following pigments is not classified as endogenous?
  • References
      • References

Additional Information

Level of Instruction: Intermediate
Intended Audience:  Clinical laboratory histotechnologists, histotechnicians, and other medical laboratory personnel who have an interest in this subject matter. This course is also appropriate for histology and medical laboratory science students, pathology residents, and practicing pathologists.  
Author Information: Brooke Eguia, BS, MS, HT(ASCP), HTL(ASCP) is the Pathology Technical Supervisor at Fairview Southdale Hospital in Edina, Minnesota. She graduated from St. Cloud State University with a Bachelor of Science degree in general biology and from Capella University with a Master of Science in Human Service with a specialization in Health Care Administration. During her time as an undergraduate, Brooke's interests and studies focused on histologic techniques and gross anatomic dissection. Acting as a primary health career mentor to high school students, Brooke satisfied her desire for training and teaching histotechnicians and also worked as adjunct faculty at Rasmussen College as a Medical Assistant laboratory techniques instructor. Most recently, she has focused on proctoring histology students in clinical/classroom progress and exam preparation.
Reviewer Information: Kristen Meyer, HTL(ASCP)CM, QIHCCM is the manager of the anatomic pathology services at Kaiser Permanente Northwest Region.

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A liver biopsy section demonstrating several forms of artifact such as chatter,</br> folds, and sponge artifact.

A liver biopsy section stained with Congo Red demonstrating amyloid

A liver biopsy stained by Masson's Trichrome demonstrating normal tissue</br> architecture and favorable tissue cassetting.

A liver biopsy stained with Gordon & Sweets reticulin stain demonstrating abnormal</br> reticulin collapse, as well as abnormal arrangement of hepatocytes.

A liver biopsy stained with Gordon & Sweets reticulin stain demonstrating normal reticulin architecture, 40X magnification.

A liver biopsy stained with Prussian blue demonstrating ferric iron in a patient</br> with hemochromatosis.

A Masson's trichrome-stained liver biopsy demonstrating an increase in type I</br> collagen in a patient with bridging portal fibrosis.