/* Sequence of slide descriptions */
desc1 = 'Slide 1
Primary Biliary Cirrhosis
A damaged medium-sized interlobular bile duct is surrounded by a dense mononuclear inflammatory infiltrate. Lymphocytes focally infiltrate bile duct epithelium. ';
desc2 = 'Slide 2
Primary Biliary Cirrhosis, Florid Duct Lesion
Granulomatous destruction of bile ducts is a characteristic histologic hallmark of primary biliary cirrhosis, although granulomas are not seen in all cases and may be absent in late stages. Epithelioid macrophages may be loosely grouped in ill defined clusters or may form a sarcoid-like granuloma, as shown here. ';
desc3 = 'Slide 3
Primary Biliary Cirrhosis, Florid Duct Lesion
The bile duct epithelium shows degenerative changes such as vacuolization and cytoplasmic granularity. ';
desc4 = 'Slide 4
Primary Sclerosing Cholangitis
Concentric periductal "onion-skinning" fibrosis with atrophy and injury to bile duct epithelium is the classic lesion seen in primary sclerosing cholangitis, but this pattern of ductal injury is not seen in all cases and may be absent in needle biopsy specimens. ';
desc5 = 'Slide 5
Sclerosing Cholangitis Associated with Primary Immunodeficiency
Sclerosing cholangitis-type changes may be seen in patients with immunodeficiencies, as in this case of common variable immunodeficiency. Such lesions are also seen in patients with AIDS. Various infectious agents such as Cryptosporidium, cytomegalovirus, and microsporidium have been implicated etiologic agents, although none was identified in this case. ';
desc6 = 'Slide 6
Sclerosing Cholangitis Associated with Primary Immunodeficiency
The interlobular bile duct shows degenerative changes, such as pyknosis, and is surrounded by loose concentric fibrosis. ';
desc7 = 'Slide 7
Adult Idiopathic Ductopenia
The liver from this 79 year old man shows a biliary pattern of cirrhosis, with "jigsaw puzzle piece" outlines to the regenerating nodules. The extrahepatic and large intrahepatic ducts were normal. ';
desc8 = 'Slide 8
Loss of Interlobular Bile Ducts in Adult Idiopathic Ductopenia
No residual bile duct is identified in many of the portal tracts in this case. Nodular scars suggestive of primary sclerosing cholangitis are not present. Proliferating bile ductules are present at the periphery of the portal tracts, but dilated biliary channels suggestive of a ductal plate malformation are not seen. ';
desc9 = 'Slide 9
Recurrent Pyogenic Cholangitis
Small portal tracts contain a mixed inflammatory infiltrate with numerous neutrophils. Portal edema and fibrosis may also be seen. ';
desc10 = 'Slide 10
Hyperplastic Changes in Bile Duct Epithelium In Recurrent Pyogenic Cholangitis
Ductal epithelium shows crowding and hyperplastic changes without nuclear pleomorphism or hyperchromasia. Cholangiocarcinoma may complicate recurrent pyogenic cholangitis, and is associated with biliary stones. ';
desc11 = 'Slide 11
Acute Rejection in Liver Allograft
A mixed portal inflammatory infiltrate composed of mononuclear cells and scattered eosinophils and neutrophils is present. The interlobular bile ducts are infiltrated by lymphocytes; reactive changes in biliary epithelium such as nuclear enlargement and cytoplasmic vacuolization may also be seen. ';
desc12 = 'Slide 12
Acute Rejection in Liver Allograft
In endothelialitis, inflammatory cells, predominantly lymphocytes, undermine the endothelium, resulting in detachment of endothelial cells from the underlying connective tissue. Endothelialitis is relatively specific for acute rejection, but is often not present in milder cases of rejection. ';
desc13 = 'Slide 13
Acute Graft-versus-host Disease
Interlobular bile ducts are the primary target in the liver in acute graft-versus-host disease. A mild lymphocytic infiltrate is often seen around the affected bile ducts, but inflammation is often minimal in relationship to the degree of bile duct injury. The bile duct epithelial cells in this example are sloughed and show degenerative changes. Lymphocytes may also infiltrate biliary epithelium.';
desc14 = 'Slide 14
Loss of Bile Ducts Associated with Drug Therapy and Toxic Epidermal Necrolysis
On low power, minimal portal and lobular inflammation is seen; perivenular and sinusoidal fibrosis is present in zone 3, and scattered canalicular bile plugs are present. ';
desc15 = 'Slide 15
Loss of Bile Ducts Associated with Drug Therapy and Toxic Epidermal Necrolysis
The portal tracts are devoid of bile ducts; no significant inflammatory infiltrate is seen. ';
desc16 = 'Slide 16
Bile Duct Injury Associated with Antibiotic Therapy
The portal triad contains a mixed inflammatory infiltrate. The interlobular bile duct is almost unrecognizable owing to heavy infiltration of duct epithelium by lymphocytes and neutrophils in this example of drug-induced cholestasis associated with amoxicillin/clavulanate (Augmentin) therapy. ';
desc17 = 'Slide 17
Congenital Hepatic Fibrosis
The hepatic parenchyma is distorted by fibrous expansion of portal tracts containing numerous abnormal biliary channels. ';
desc18 = 'Slide 18
Congenital Hepatic Fibrosis
Dysmorphic anastomosing biliary channels are arranged around the perimeter of the enlarged portal tracts. ';
desc19 = 'Slide 19
Polycystic Liver Disease
Multiple unilocular cysts of varying sizes are found in the liver in polycystic liver disease. Biliary hamartomas, or von Meyenburg complexes, are frequently found in the vicinity of the cysts and probably give rise to them by progressive accumulation of fluid. ';
desc20 = 'Slide 20
Polycystic Liver Disease
The cysts of autosomal dominant polycystic disease involving the liver are lined by a simple cuboidal to low columnar biliary-type epithelium. ';
desc21 = 'Slide 21
Caroli\'s Disease
Involvement of the large intrahepatic bile ducts by the ductal plate malformation process gives rise to congenital dilatation of bile ducts in Caroli\'s disease. These dilated ducts are predisposed to bile stasis, stone formation, and infection. ';
desc22 = 'Slide 22
Bile Duct Epithelial Hyperplasia in Caroli\'s Disease
Biliary epithelial hyperplasia may be seen in ducts involved by Caroli\'s disease. Rarely, frank epithelial dysplasia, which may represent the precursor of cholangiocarcinoma, is seen. ';
desc23 = 'Slide 23
Perihilar Cholangiocarcinoma Arising in Primary Sclerosing Cholangitis
The typical cholangiocarcinoma is well to moderately differentiated, and the tumor cells closely resemble biliary epithelium. A dense desmoplastic stroma usually accompanies the tumor, even in cases not arising in primary sclerosing cholangitis. ';
desc24 = 'Slide 24
Perineural Invasion in Cholangiocarcinoma
Peri- and intraneural spread is common in cholangiocarcinomas and may serve as a helpful clue to diagnosis of malignancy in small specimens. ';
desc25 = 'Slide 25
Adenocarcinoma Arising in Biliary Cystadenoma
Cytologically malignant cells forming cribriform and papillary structures infiltrate the cyst wall. ';
desc26 = 'Slide 26
Biliary Cystadenoma with Mesenchymal Stroma
The cysts of biliary cystadenoma are lined by simple columnar to cuboidal epithelium; goblet cells are occasionally seen. The underlying mesenchymal stroma may be densely packed and resemble ovarian stroma, a feature found exclusively in female patients. ';
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