Contribution to Liver Disorders in Childhood – Analysis of the Histological Findings in 100 Core Needle Biopsies
Authors:
V. Bartoš 1,3; R. Szépeová 2; P. Slávik 3; Ľ. Lauko 3; J. Buchanec 2; M. Adamkov 1
Authors place of work:
Ústav histológie a embryológie JLF UK, Martin
vedúci doc. MUDr. K. Belej, CSc.
1; Klinika detí a dorastu JLF UK a MFN, Martin
vedúci prof. MUDr. P. Bánovčin, CSc.
2; Ústav patologickej anatómie JLF UK a MFN, Martin
vedúci prof. MUDr. L. Plank, CSc.
3
Published in the journal:
Čes-slov Pediat 2008; 63 (9): 473-480.
Category:
Original Papers
Summary
Introduction:
Liver biopsy examination plays an important role in assessment of accurate diagnosis of the liver diseases and various non-specified hepatopathies in pediatric practice.
Aim of the study:
The goal of this study was the retrospective analysis of the histomorphological findings in liver biopsy specimens of children and analysis of morphological diagnoses of individual disorders.
Patients and methods:
The histological parameters of percutaneous core needle biopsies of 100 pediatric patients were observed. All children were admitted to hospital because of certain liver disorder or various hepatic damage of unknown origin. The age of children varied from 3 months to 18 years (9.7 yr. average), boy-to-girl ratio was 56 : 44. 11 patients had less than 12 months at the time of biopsy. The fixed tissues were processed under the standard conditions using special histochemical and immunohistochemical staining methods and evaluated by pathologists. Histological grading and staging of chronic hepatitis were evaluated according to modified Histology Activity Index criteria proposed by Ishak. Authors used only descriptive evaluation for other histomorphological findings.
Results:
The most frequent morphological diagnoses (n=66) were the inflammatory changes of tissue, especially chronic hepatitis predominated. There were recognised 22 cases of chronic hepatitis B, 6x chronic hepatitis C, 4x autoimmune hepatitis, 1 chronic cholangitis and 7 cases of chronic hepatitis of unknown origin. Acute or non-specific reactive hepatitis were present in 26 children including 4 cases of CMV (cytomegalovirus) and 1 case of EBV (Epstein-Barr virus) infection. Findings associated with congenital and genetic-metabolic pathological entities (2x suspected Byler’s syndrome, 2x congenital cholestatic hepatopathy not otherwise specified, 1x diabetic hepatopathy, 2x susp. Wolman’s disease or Niemann-Pick’s disease, 1x atresia or hypoplasia of the intrahepatic bile ducts, 1x extrahepatic biliary atresia) predominated in small children, mostly in infants. Simple hepatic fibrosis occurred in 3 cases and complete cirrhosis in 3 other cases. A picture of individual siderosis (n=3) and steatosis, including steatohepatitis (n=7) was relatively rare, because a pathological accumulation of lipids, bile, and iron pigment of various degree was related to the broad spectrum of nosological entities also with secondary reactive inflammatory changes. No significant histological features in liver biopsy samples were in 9 children.
Conclusion:
The histomorphological liver findings in children are often similar in various nosological entities and are mostly associated with inflammatory or reactive changes of the parenchyma. Diagnostically, the most difficult are early phases of diseases. A histological examination gives especially the information about morphological stage that is very important for prognosis of the patient. It provides the less relevant data about etiology.
Key words:
liver biopsy, hepatitis, non-alcoholic fatty liver disease, metabolic disorders
Zdroje
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Štítky
Neonatology Paediatrics General practitioner for children and adolescentsČlánok vyšiel v časopise
Czech-Slovak Pediatrics
2008 Číslo 9
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