The lesion, bile ductular cholestasis (inspissated bile concretions within proliferated periportal bile ductular structures), is pathognomonic for sepsis.
In fulminant hepatitis, activation of periportal progenitor cells frequently occurs to produce numerous periportal proliferating bile ductules (neocholangiolar proliferation), but they typically do not contain inspissated bile.
In acute large bile duct obstruction, the trio of changes characteristically present in the portal tract includes edema, proliferation of bile ductules (without inspissated bile), and a mild neutrophil infiltrate. An exception is a liver biopsy specimen obtained within the first few months of life in cases of extrahepatic biliary atresia, where the presence of inspissated bile within periportal bile ductular structures is helpful in establishing the diagnosis of biliary atresia.
Cholestasis in drug hepatotoxicity usually manifests as centrilobular hepatocellular or bile canalicular bile stasis and not bile ductular cholestasis.
The brown pigment seen in the liver section is bile, not melanin, and it is present within bile ductular structures (not within tumor cells).