[1706] Fibrosing Cholestatic Hepatitis C Versus Biliary Obstruction: Distinguishing Histopathologic Features

Marcela Salomao, Jay H Lefkowitch, Elizabeth C Verna, Roger K Moreira. Columbia University, New York, NY; Mayo Clinic, Rochester, MN

Background: The histopathologic distinction between posttransplantation fibrosing cholestatic hepatitis C (FCH-C) and biliary obstruction is challenging. We sought to identify histopathologic features that could be useful in the differential diagnosis between these two entities.
Design: Thirty eight cases of HCV-negative, cholangiography-proven biliary obstruction (including 16 post-transplant and 22 non-transplant patients [M:16, F:22; mean age 46.3 [13-81 yrs]), and 13 patients with posttransplantation FCH-C (M=9, F=4, mean age 57.3 [32-72 yrs]) were included. FCH-C patients were characterized by cholestatic disease (bilirubin >2 mg/dL), high HCV viral load, no evidence of biliary tract obstruction on imaging, and typical histopathologic findings (≥3 of the following: prominent ductular reaction, hepatocyte ballooning, periportal sinusoidal fibrosis and cholestasis). Biopsies were evaluated with H&E, trichrome, Victoria Blue, and rhodanine stains as well as CK7 immunohistochemistry. A “biliary” CK7 pattern was defined by abundant CK7+ (“biliary” or “metaplastic”) hepatocytes in the periportal area, while “FCH” pattern was characterized by few or no CK7+ hepatocytes in spite of prominent ductular reaction.
Results:

 Biliary obstruction n=38FCH n=13p value
Bile duct dilatation26.3% (10/38)0% (0/13)0.0003
Neutrophils in ductular reaction94.7% (36/38)100% (13/13)NS
Portal edema63.1% (24/38)7.6% (1/13)<0.0001
Ductular cholestasis21% (8/38)7.6% (1/13)0.18
Hepatocyte swelling with lobular disarray5.2% (2/38)84.6% (11/13)<0.0001
Lobular inflammation (Hepatitis Activity Index, score)1 (0-2)2 (1-3)NS
Cholestasis65.7% (25/38)76.9% (10/13)0.43
Periportal sinusoidal fibrosis34.2% (13/38)100% (13/13)<0.0001
Copper (rhodanine)60.5% (23/38)15.3% (2/13)0.0006
Copper-binding protein (Victoria blue)47.3% (18/38)0% (0/13)<0.0001
CK7 expression•FCH pattern: 26.4% (10/38) •Biliary pattern: 73.6% (28/38)•FCH pattern: 92.3% (12/13) •Biliary pattern: 7.7% (1/13)<0.0001
NS: Not significant (p>0.05)


Conclusions:

 Favors biliary obstruction:Favors FCH:
H&E and trichrome stains•Bile duct dilatatio•Portal edema •Acute cholangitis•Bile infarcts •Periductal fibrosis•Hepatocyte swelling w/ lobular disarray •Periportal sinusoidal fibrosis
Copper/copper-binding protein stainsPresent, especially if abundantAbsent, despite pronounced ductular reaction
CK7 patternAbundant CK-7+ periportal hepatocytesNo/few CK7+ hepatocytes despite pronounced ductular reaction



Category: Liver

Monday, March 4, 2013 1:15 PM

Proffered Papers: Section E, Monday Afternoon

 

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