Systemic pathology: autoimmune hepatitis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Systemic pathology: autoimmune hepatitis

Sample item

A 32-year-old woman has fatigue, jaundice and raised transaminases with hypergammaglobulinaemia and anti-smooth muscle antibodies. What would liver biopsy show?

AConcentric periductal fibrosis with a beaded duct patternBGranulomatous destruction of interlobular bile ductsCGround-glass hepatocytes with orcein-positive cytoplasmDInterface hepatitis with abundant plasma cells

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Interface hepatitis with abundant plasma cells

Autoimmune hepatitis shows interface hepatitis (piecemeal necrosis) with a lymphoplasmacytic infiltrate rich in plasma cells, often with rosettes. It occurs mainly in women, is associated with raised IgG and responds to immunosuppression. Biliary patterns and viral inclusions indicate other diseases.

Option by option

A. Concentric periductal fibrosis with a beaded duct pattern
Onion-skin periductal fibrosis with beading describes primary sclerosing cholangitis.
B. Granulomatous destruction of interlobular bile ducts
Granulomatous bile duct destruction describes primary biliary cholangitis, with antimitochondrial antibodies.
C. Ground-glass hepatocytes with orcein-positive cytoplasm
Ground-glass hepatocytes are HBsAg-laden cells of chronic hepatitis B.
D. Interface hepatitis with abundant plasma cells (correct)
Correct. Plasma cell-rich interface hepatitis is the hallmark of autoimmune hepatitis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Interface hepatitis with abundant plasma cells. Autoimmune hepatitis shows interface hepatitis (piecemeal necrosis) with a lymphoplasmacytic infiltrate rich in plasma cells, often with rosettes.

Why is "Concentric periductal fibrosis with a beaded duct pattern" not the answer?

Onion-skin periductal fibrosis with beading describes primary sclerosing cholangitis.

Why is "Granulomatous destruction of interlobular bile ducts" not the answer?

Granulomatous bile duct destruction describes primary biliary cholangitis, with antimitochondrial antibodies.

Why is "Ground-glass hepatocytes with orcein-positive cytoplasm" not the answer?

Ground-glass hepatocytes are HBsAg-laden cells of chronic hepatitis B.

What concept does this question test?

It tests Systemic pathology: autoimmune hepatitis in Pathology. It occurs mainly in women, is associated with raised IgG and responds to immunosuppression. Biliary patterns and viral inclusions indicate other diseases.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic pathology: autoimmune hepatitis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.