Perivenular Biliary Metaplasia of Hepatocytes and Not a Periportal Ductular Reaction Correlates with a Cholestatic Liver Chemistry Profile in Patients with Hepatic Venous Outflow Obstruction
RK Pai, J Hart. Washington University, St. Louis; Univ. of Chicago, Chicago
Background: Patients with venous outflow obstruction often have an unexpected cholestatic pattern of liver chemistry tests. Elevations in alkalaine phosphatase and bilirubin 2 to 5 times normal is not unusual. Kakar et al recently described portal changes in patients with outflow obstruction (Mod Path 2004 17:874). In this study ∼50% of patients had evidence of a bile ductular reaction. However, no patient had evidence of biliary tract disease. They argued that such changes could account for the cholestatic profile. However, it is unclear if a ductular reaction can explain the cholestatic profile in all patients with outflow obstruction.
Design: 22 needle liver biopsies from patients with congestive heart failure were analyzed histologically and immunohistochemically for CK7. Histologic parameters were degree of sinusoidal dilatation, fibrosis, ductular reaction, and portal inflammation. The patient's liver chemistry tests at the time of biopsy was recorded.
Results: We found that 32% of patients (7 of 22) had histologic evidence of mild periportal ductular reaction. A CK7 immunostain demonstrated a subtle periportal ductular reaction in two additional cases. Strikingly, the CK7 immunostain also demonstrated prominent biliary metaplasia of perivenular hepatocytes in the majority of cases (focal zone-3 in 11, diffuse zone-3 in 3, and diffuse zones-3 and -2 in 5 patients). The presence of a periportal ductular reaction did not correlate with a cholestatic liver chemistry profile (Table 1). However, the degree of sinusoidal dilatation as well as perivenular biliary metaplasia was a strong predictor of a cholestatic profile.
|Zone 3 (focal and diffuse)||14||1.90||169||30||40|
|Diffuse Zones 2-3||5||3.90||193||18||27|