In hereditary hemochromatosis, which liver biopsy finding is associated?

• A. Normal iron deposition
• B. No iron deposition
• C. Fatty infiltration without iron deposition
• D. Increased liver parenchymal hemosiderin

Answer: (D)

The main idea is iron overload in the liver. In hereditary hemochromatosis, too much iron is absorbed and delivered to the liver, where it accumulates first in hepatocytes as hemosiderin. On a biopsy this shows up as increased parenchymal iron stores (often seen as brown pigment that stains blue with Prussian blue), reflecting siderosis from the excess iron. This parenchymal iron deposition is the hallmark finding.

Normal or absent iron deposition wouldn’t fit a condition with systemic iron overload, and fatty infiltration without iron deposition points to a fatty liver process unrelated to hemochromatosis.