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‘ workplace:
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:
Čes-slov Pediat 2008; 63 (9): 473-480.
Category:
Original Papers
Overview
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
Sources
1. Arya G, Balistreri WF. Pediatric liver disease in the United States: Epidemiology and impact. J. Gastroenterol. Hepatol. 2002;17: 521–525.
2. Burki MK, Orakzai SA. The prevalence and pattern of liver disease in infants and children in Hazara Division. J. Ayub. Med. Coll. Abbottabad. 2001;13(1): 26–28.
3. Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J. Hepatol. 1995;22(6): 396–399.
4. Zhang HF, Yang XJ, Zhu SS, et al. Pathological changes and clinical manifestations of 1020 children with liver diseases confirmed by biopsy. Hepatobiliary Pancreat. Dis. Int. 2004;3(3): 395–398.
5. Ahmad M, Afzal S, Roshan E, et al. Usefulness of needle biopsy in the diagnosis of paediatric liver disorders. J. Pak. Med. Assoc. 2005;55(1): 24–28.
6. Fujisawa T, Inui A, Komatsu H, et al. A comparative study on pathologic features of chronic hepatitis C and B in pediatric patients. Fetal and Pediatric Pathology 2000;19(6): 469–480.
7. Iorio R, Pensati P, Botta S, et al. Chronic cryptogenic hepatitis in childhood is unrelated to G virus. Pediatr. Infect. Dis. J. 1999;18(4): 347–351.
8. Gregorio GV, Pensati P, Iorio R, et al. Autoantibody prevalence in children with liver disease due to chronic hepatitis C virus (HCV) infection. Clin. Exp. Immunol. 1998;112: 471–476.
9. Gregorio GV, Choudhuri K, Ma Y, et al. Mimicry between the hepatitis B virus DNA polymerase and the antigenic targets of nuclear and smooth muscle antibodies in chronic hepatitis B virus infection. J. Immunol. 1999;162: 1802–1810.
10. Piñeiro-Carrero MV, Piñeiro EO. Liver. Pediatrics 2004;113(Suppl 4): 1097–1106.
11. Clark BD, Lynch GK, Donovan JE, Block DG. Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates, Alcohol Clin. Exp. Res. 2001;25(9): 1350–1359.
12. Kuchta M, Nováková B, Gombošová K, Petrášová M. Steatóza pečene a obezita detí a dospievajúcich. Pediatria 2007;2(1): 18–22.
13. Rashid M, Roberts EA. Nonalcoholic steatohepatitis in children. J. Pediatr. Gastroenterol. Nutr. 2000;30: 48–53.
14. Schwimmer JB, Behling C, Newbury R, et al. Histopathology of pediatric nonalcoholic fatty liver disease. Hepatology 2005;42: 651–649.
15. Marion AW, Baker AJ, Dhawan A. Fatty liver disease in children. Arch. Dis. Child. 2004;89: 648–652.
1 6. Fiľková E. Cholestáza v detskom veku v praxi pediatra. Revue Medicíny v Praxi 2007;5(3): 13–15.
17. Kotalová R, Cebecauerová D, Knisely A, et al. Progressive familial intrahepatic cholestasis – manifestation and diagnosis in infancy. Čes.-slov. Pediat. 2006;61(4): 200–206.
18. Bartoš V, Lauko Ľ, Szépeová R, a spol. Bylerov syndróm. Čes.-slov. Pediat. 2006;61(1): 32–35.
19. Bátorová M, Haferová L, Hrušovský Š, a spol. Hereditárna hemochromatóza. Gastroenterol. Prax. 2006;5(1): 43–47.
20. Murray FK, Kowdley VK. Neonatal hemochromatosis. Pediatrics 2001;108(4): 960–964.
21. Procházková D, Konečná P, Vrábelová S, a spol. Význam molekulárně-genetického vyšetření pro diagnostiku Wilsonovy choroby. Čes.-slov. Pediat. 2005;60(4): 188–199.
22. Belovičová M, Hrušovský Š, Bátorová M, Pružincová Ľ. Wilsonova choroba. Gastroenterol. Prax. 2006;5(1): 48–54.
23. Dalgic B, Sari S, Gündüz M, et al. Cholesteryl ester storage disease in a young child presenting as isolated hepatomegaly treated with simvastatin. Turk. J. Pediatr. 2006;48: 148–151.
24. Seemanová E. Alagilleův syndrom – arteriohepatická dysplazie. Čes.-slov. Pediat. 2003;58(6): 381–383.
25. Balistreri FW. Intrahepatic cholestasis. J. Pediatr. Gastroenterol. Nutr. 2002;35(Suppl 1): 17–23.
26. Takeyama J, Saito T, Itagaki T, Abukawa D. Vanishing bile duct syndrome with a history of erythema multiforme. Pediatrics International. 2006;48(6): 651–653.
27. Kotalová R, Bláhová K, Janda J, a spol. Biliární atrézie – incidence a výsledky léčby v České republice. Čes.-slov. Pediat. 2003;58(5): 299–303.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2008 Issue 9
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