Virtual Pathology Grand Rounds: A Practical Diagnostic Approach to Neonatal Cholestasis

Neonatal cholestasis includes a myriad of disorders characterized by conjugated hyperbilirubinemia with their early recognition being crucial in their treatment and prognosis. The leading cause of neonatal cholestasis is biliary atresia which is the most common indication for pediatric liver transplantation worldwide. During the workup of these patients one of the crucial components is the evaluation of liver biopsies which in the hands of an experienced pathologists has a positive predictive value for biliary atresia of ~90%. The histologic changes in these biopsies can be grouped in three histologic patterns: obstructive, neonatal hepatitis (giant cell hepatitis) and bile duct paucity. Each one of these patterns is associated with several important diagnostic considerations. In this virtual grand round, we will discuss a practical approach to these challenging biopsies with an emphasis in grouping these cases in one of those histologic groups particularly the obstructive pattern given its treatment implications.