[1571] Does Rhodanine Stain Help Differentiate Venous Outflow Impairment from Chronic Biliary Disease in Liver Biopsies?

Taofic Mounajjed, Thomas C Smyrk. Mayo Clinic, Rochester, MN

Background: Venous outflow impairment (VOI) can occasionaly mimic chronic biliary disease (CBD) histologically and by liver biochemistry profile. In this study, we ask whether histochemical demonstration of copper accumulation in hepatocytes by rhodanine stain can aid in differentiating between VOI and CBD.
Design: Pathology files were searched for liver cases demonstrating all stages of VOI and CBD [including primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC)] between 1987 and 2010. We applied a rhodanine stain to all biopsies, and scored stainable copper as follows: no copper = 0, copper accumulation in rare periportal hepatocytes =1, patchy periportal staining = 2, circumferential periportal staining =3; diffuse staining in periportal and non-periportal hepatocytes =4. Clinical and laboratory data as well as H&E and trichrome stained slides were reviewed to confirm diagnosis and stage of disease.
Results: Prevalence and mean score of stainable copper in 64 VOI patients (13 acute & 51 chronic; 26 veno-occlusive disease + 21 Budd-Chiari + 9 congestive heart failure + 8 amyloidosis; 33 female & 31 male; 18 to 84 years) and 123 CBD patients (51 PBC & 72 PSC; 66 female & 57 male; 22 to 87 years) is demonstrated in table 1.

Prevalence and (mean score) of copper in VOI and CBD patients
Stage (S)VOICBD
S10/15 (0)14/37 (0.6)
S21/14 (2)24/32 (1.1)
S31/9 (1)30/33 (2.6)
S45/13 (1.6)21/21 (3.3)


Rhodanine was negative in all cases of acute VOI. Stainable copper was detected in 7/51 chronic VOI patients (5 veno-occlusive disease, 1 Budd-Chiari, & 1 heart failure) and in 89/123 CBD patients (35 PBC & 54 PSC). In all stages, the prevalence of stainable copper was significantly higher in CBD patients compared to VOI patients (stage 1: p=0.0005, stage2, 3, & 4: p<0.0001). Similarly, the mean copper score was significantly higher in CBD patients compared to VOI patients (p<0.0001). With only 2 exceptions, rhodanine was always negative in stage 1-3 VOI. An unusual pattern of sub-capsular copper accumulation was observed in 2 stage 4 VOI cases.
Conclusions: In all stages of liver disease, copper accumulates in hepatocytes more frequently and more extensively in CBD compared to VOI. In liver biopsies displaying stage 1-3 fibrosis, rhodanine stain is a valuable aid in differentiating between VOI and CBD. In contrast, once stage 4 fibrosis has evolved, copper accumulation can be observed in 38.5% of VOI patients, and is therefore less reliable in differentiating VOI from CBD.
Category: Liver & Pancreas

Wednesday, March 2, 2011 9:30 AM

Poster Session V # 186, Wednesday Morning

 

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