Clinical Associations of Ito Cell Hyperplasia
Rondell Graham, Taofic Mounajjed, Schuyler Sanderson. Mayo Clinic, Rochester, MN
Background: Ito cell hyperplasia (ICH) characterized by H&E identifiable, prominent peri-sinusoidal hepatic stellate cells laden with lipid droplets, has been principally attributed to hypervitaminosis A. Although sporadic reports of ICH in other liver diseases such as chronic biliary disease exist, clinical associations of this entity have not been studied in detail. We aimed to examine the clinical conditions, other than hypervitaminosis A, in which ICH occurs.
Design: By searching our pathology database, we identified 34 patients (15 male and 19 female) ranging in age between 4 and 77 years old (median: 56) whose liver biopsy demonstrated ICH (between 1997 and 2011). We re-examined the routine sections (H&E, trichrome, PAS-D, and iron) of the original and any follow up liver biopsies to confirm the presence ICH and evaluate any additional histologic changes. Clinical, radiologic, and laboratory data (including serum vitamin A levels) were reviewed and their relationship to ICH was examined.
Results: ICH occurred in 24 native and 10 transplant liver biopsies. All patients used medications and (82%) were multi-medicated. 99 different drugs were used at the time of the liver biopsy, most frequently, prednisone, proton pump inhibitors and furosemide. In 30 (of 34) patients, there was no clinical or laboratory evidence of hypervitaminosis A. Based on clinical, laboratory and histologic features, the biopsies were classified as follows:
1. Native livers
a. Drug induced hepatitis (n=6), histologically pan-acinar (n=4) or reactive (n=2). Niacin was the most frequent inciting agent (3 of 6)
b. Chronic liver disease (n=10): chronic hepatitis C (n=4), autoimmune hepatitis (n=3), steatohepatitis (n=1), chronic biliary disease (n=1), and portal venopathy (n=1).
c. Non-specific reactive hepatitis (n=4); related to systemic illness (n=2) or inflammatory gastrointestinal disorder (n=2).
d. Hypervitaminosis A (n=4)
2. Transplanted livers
a. Bile outflow impairment (n=5)
b. No significant abnormalities in routine allograft biopsy (n=4)
c. Resolving acute cellular rejection (n=1)
Follow-up biopsies were available in 5 patients at intervals ranging from 15 days to 16 months; in 2 patients, progression of fibrosis was observed in the setting of chronic biliary disease, and the remaining 3 patients showed no fibrosis.
Conclusions: ICH is an uncommon and relatively nonspecific finding that most commonly occurs in multi-medicated patients, often in the absence of hypervitaminosis A. It occurs in association with drug toxicity such as Niacin, chronic liver disease, systemic illness or inflammatory disorders of the gastrointestinal tract, as well as in the post liver transplant setting.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 257, Monday Morning