Liver and Biliary Pathology Practice Questions

Q: Councilman bodies are seen in which of the following conditions?

Acute viral hepatitis. **Explanation:** **Councilman bodies** (also known as acidophilic bodies or apoptotic bodies) are a hallmark histopathological finding in **Acute Viral Hepatitis** (most commonly Yellow Fever, but also Hepatitis A, B, and C) [1]. 1. **Why Acute Viral Hepatitis is correct:** Councilman bodies represent individual hepatocytes undergoing **apoptosis** [1]. During acute viral infection, cytotoxic T-cells induce programmed cell death in infected hepatocytes. Morphologically, these cells shrink, lose their nuclei (pyknosis/karyorrhexis), and become intensely **eosinophilic** (pink-staining) globes that are often extruded into the space of Disse [1]. 2. **Why other options are incorrect:** * **Alcoholic Cirrhosis:** The characteristic inclusion here is the **Mallory-Denk body**, which consists of damaged intermediate filaments (cytokeratin). These appear as "rope-like" eosinophilic inclusions, not apoptotic bodies. * **Wilson’s Disease:** While it can show various features, the classic findings include copper accumulation (demonstrated by Rhodanine stain) and fatty change, rather than isolated Councilman bodies. * **Autoimmune Hepatitis:** This is characterized by **Interface Hepatitis** (piecemeal necrosis) and a dense infiltrate of **plasma cells**. **High-Yield Clinical Pearls for NEET-PG:** * **Councilman Body = Apoptosis:** Always associate Councilman bodies with hepatocyte apoptosis [1]. * **Yellow Fever:** Classically, Councilman bodies were first described in Yellow Fever. * **Mallory Bodies vs. Councilman Bodies:** Mallory bodies are "intracytoplasmic" (damaged filaments), whereas Councilman bodies are "entire shrunken cells" (apoptotic). * **Staining:** Councilman bodies stain bright pink with H&E stain and are PAS positive. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Liver And Biliary System Disease, pp. 386-387.

Question 1

A 45-year-old chronic alcoholic patient developed ascites and decreased libido. Physical examination revealed mild enlargement of the breasts and atrophy of testes. A liver biopsy was done. All of the following are probable findings seen in histopathologic examination, EXCEPT?

Accepted Answer

Necrosis and infiltration of neutrophils within hepatic lobules

Answer

Complete disruption of hepatic lobular architecture

Answer

Bands of fibrosis

Answer

Regenerating lobules

Question 2

Hemochromatosis presents with all EXCEPT:

Accepted Answer

Hepatitis

Answer

Micronodular cirrhosis

Answer

Diabetes mellitus

Answer

Skin pigmentation

Question 3

Anti-mitochondrial antibody is typically seen in which of the following conditions?

Accepted Answer

Primary biliary cirrhosis

Answer

Hepatic cirrhosis

Answer

Cardiac cirrhosis

Answer

Primary sclerosing cholangitis

Question 4

Councilman bodies are seen in which of the following conditions?

Accepted Answer

Viral hepatitis

Answer

Molluscum contagiosum

Answer

Rabies

Answer

Granuloma inguinale

Question 5

All of the following conditions may show Mallory Hyaline changes except?

Accepted Answer

Hepatitis E

Answer

Wilson disease

Answer

Indian childhood cirrhosis

Answer

Primary biliary cirrhosis

Question 6

Which of the following are histopathologic features of bile duct obstruction?

Accepted Answer

All of the above

Answer

Proliferation of bile duct

Answer

Bile lakes

Answer

Portal fibrosis

Question 7

Which of the following is the single most important indicator of the likelihood of progression of hepatitis to liver cirrhosis?

Accepted Answer

Etiology

Answer

Associated serological findings

Answer

Presence of bridging necrosis

Answer

Presence of Mallory hyaline

Question 8

Councilman bodies are seen in which of the following conditions?

Accepted Answer

Acute viral hepatitis

Answer

Alcoholic cirrhosis

Answer

Wilson's disease

Answer

Autoimmune hepatitis

Question 9

Periportal fatty infiltration of the liver is seen with which of the following conditions?

Accepted Answer

Malnutrition

Answer

Alcoholism

Answer

Viral hepatitis

Answer

Tetracycline

Question 10

Antimitochondrial antibodies are characteristically seen in which of the following conditions?

Accepted Answer

Primary biliary cirrhosis

Answer

Secondary biliary cirrhosis

Answer

Neonatal hepatitis

Answer

Neonatal cholestasis

Liver and Biliary Pathology — MCQs

Liver and Biliary Pathology — MCQs

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