[1677] Hepatic Outflow Obstruction: Underappreciated Histologic Features on Biopsy

Michael Alan Gilger, Mary Kay Washington. Vanderbilt University School of Medicine, Nashville, TN

Background: Cardiac hepatopathy (CH) and Budd-Chiari Syndrome (BCS) are two disease entities with significantly different pathophysiology but overlapping histologic findings. We hypothesized that a constellation of biopsy findings can help distinguish between the two, and suggest the diagnosis of CH in previously undiagnosed patients.
Design: 42 patients, 17 with a diagnosis of CH and 25 with a diagnosis of BCS were identified by searching the surgical pathology database from 1983-2012. Hematoxylin & Eosin and trichrome stained slides were evaluated for histologic features listed in Table 1.

Histologic Findings of Cardiac Hepatopathy vs. Budd Chiari Syndrome
 Cardiac HepatopathyBudd Chiari Syndrome
Sinusoidal Dilatation94.1%88%
Bile Ductular Reaction70.6%72%
Centrilobular Inflammation52.9%8%
Portal Inflammation41.2%52%
Centrilobular Dropout/Necrosis41.2%76%
Portal-based Fibrosis71.4%68%
Centrilobular Fibrosis92.6%60%
Sinusoidal Fibrosis85.7%48%

Results: Features common to both forms of hepatic outflow obstruction were sinusoidal dilatation, and portal tract changes of fibrosis, chronic inflammation, and bile ductular reaction (Table 1). Histologic findings significantly more common in CH included centrilobular fibrosis (p=0.02), sinusoidal fibrosis (p=0.014), and patchy centrilobular mixed inflammation (p<0.01). Only centrilobular hepatocyte dropout/necrosis was significantly more common in BCS (p=0.01). The focal zone 3 inflammation seen in CH, albeit mild, was unusual in that admixed neutrophils were frequently present in the infiltrate (Figure 1).

Conclusions: The finding of centrilobular and sinusoidal fibrosis in CH compared to BCS is not unexpected, given the chronic nature of most CH. Portal tract changes are common in both forms of hepatic outflow obstruction and should not deter one from making the diagnosis of hepatic outflow obstruction. An unusual pattern of patchy mixed zone 3 inflammation with neutrophils was noted in CH. Centrilobular and sinusoidal fibrosis and dilatation, with or without focal zone 3 inflammation may be suggestive of CH in biopsies from patients without a prior diagnosis.
Category: Liver

Wednesday, March 6, 2013 1:00 PM

Poster Session VI # 113, Wednesday Afternoon


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