Histologic pathology of the Liver in Progressive Familial Intrahepatic Cholestasis

Estella M. Alonso, Dale C. Snover, Anthony Montag, Deborah K. Freese, Peter F. Whitington*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

114 Scopus citations


This work details the histologic findings in 84 liver biopsy specimens from 28 patients with progressive familial intrahepatic cholestasis (PFIC), who met the clinical criteria of early onset of chronic unremitting cholestasis, exclusion of any known metabolic or anatomic etiology, and low serum γ-glutamyl transpeptidase (GGTP) values. Hepato-canalicular cholestasis and disruption of the liver cell plate arrangement were early, uniform findings, and giant cell transformation was found in 56% of initial biopsies. Duct loss was a prominent finding; 70% of patients had ductal paucity, and many had abnormal bile duct epithelium, suggesting degeneration. Fibrosis was seen in the samples from 16 patients, including bridging fibrosis in specimens obtained from six patients during the first 2 years of life. Proliferating ductules at the margins of portal tracts increased as fibrosis progressed and were especially prominent in end-stage histology. Cirrhosis developed in nine of these patients and had a characteristic histologic pattern, consisting of biliary cirrhosis with diffuse stellate lobular fibrosis associated with severe cholestasis and pseudoacinar transformation. Mal-lory hyalin and hepatocellular carcinoma were observed in materials from some patients with advanced cirrhosis. The constellation of histologic findings in PFIC forms a recognizable pattern, and the liver histology appears to have a predictable progression.

Original languageEnglish (US)
Pages (from-to)128-133
Number of pages6
JournalJournal of pediatric gastroenterology and nutrition
Issue number2
StatePublished - Feb 1994


  • Byler disease
  • Cirrhosis
  • Ductal paucity
  • Familial cholestasis
  • Giant cell hepatitis
  • Hepatocellular carcinoma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology


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