Last updated: 11/24/2009

After the biopsy, the liver sample is sent to the pathology laboratory and examined. A normal (negative) result would find no evidence of pathology in the tissue sample. It should be noted that many diseases of the liver are focal and not diffuse;...

an abnormality may not be detected if the sample was taken from an unaffected site. If symptoms persist, the patient may need to undergo another biopsy.

The pathologist will perform a visual inspection of the sample to note any abnormalities in appearance. In cirrhosis, the sample will be fragmented and hard. Fatty liver, seen in heavy drinkers, will float in the formalin solution and will be yellow. Carcinomas are white. The pathologist will also look for deposition of bile pigments (green), indicating cholestasis (obstruction of bile flow). In preparation for microscopic examination, the tissue will be frozen and cut into thin sections, which will be mounted on glass slides and stained with various dyes to aid in identifying microscopic structures. Using the microscope, the pathologist will examine the tissue samples, and identify abnormal cells and any deposited substances such as iron or copper. In liver cancer, small dark malignant cells will be visible within the liver tissue. An infiltration of white blood cells may signal infection. The pathologist also checks for the number of bile ducts, and determines whether they are dilated. He or she also looks at the health of the small arteries and portal veins. Fibrosis will appear as scar tissue, and fatty changes are diagnosed by the presence of lipid droplets. Many different findings may be noted and a differential diagnosis (one out of many possibilities) can often be made. In difficult cases, other laboratory tests such as those assessing liver function enzymes will aid the clinician in determining the final diagnosis.