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Hepatobiliary practical: how to get the best out of a liver biopsy

Looi LM

Med J Malaysia, 2005 Jul;60 Suppl B:144-5.
PMID: 16108199

The liver biopsy has a unique place in the investigation of liver disease because the concepts and classification of liver disease are rooted in morphology. Today, the use of the liver biopsy has extended beyond that of diagnosis, to the assessment of disease progression, response to therapy and transplant rejection. To get the best out of the liver biopsy, it is necessary to appreciate the usefulness and limitations of the biopsy specimen. Aspects to consider include: (1) minimizing sampling errors, and appreciating that the changes in the biopsy may not be representative of the primary pathology, (2) good laboratory quality practices to avoid processing artifacts, which may render a biopsy undiagnosable, (3) the appropriate use of special stains and other laboratory techniques, (4) adoption of a systematic and algorithmic approach in the microscopic examination of the biopsy, and (5) good clinicopathological correlation.

Matched MeSH terms: Liver Diseases/pathology*
Focal nodular hyperplasia of the liver

Chong KC

Med J Malaysia, 1974 Jun;28(4):296-9.
PMID: 4278779
Matched MeSH terms: Liver Diseases/pathology*
Mitochondrial hepatopathies: advances in genetics and pathogenesis

Lee WS, Sokol RJ

Hepatology, 2007 Jun;45(6):1555-65.
PMID: 17538929

Hepatic involvement is a common feature in childhood mitochondrial hepatopathies, particularly in the neonatal period. Respiratory chain disorders may present as neonatal acute liver failure, hepatic steatohepatitis, cholestasis, or cirrhosis with chronic liver failure of insidious onset. In recent years, specific molecular defects (mutations in nuclear genes such as SCO1, BCS1L, POLG, DGUOK, and MPV17 and the deletion or rearrangement of mitochondrial DNA) have been identified, with the promise of genetic and prenatal diagnosis. The current treatment of mitochondrial hepatopathies is largely ineffective, and the prognosis is generally poor. The role of liver transplantation in patients with liver failure remains poorly defined because of the systemic nature of the disease, which does not respond to transplantation. Prospective, longitudinal, multicentered studies will be needed to address the gaps in our knowledge in these rare liver diseases.

Matched MeSH terms: Liver Diseases/pathology*
Fulltext Usefulness of a scoring system in the interpretation of histology in neonatal cholestasis

Lee WS, Looi LM

World J Gastroenterol, 2009 Nov 14;15(42):5326-33.
PMID: 19908342 DOI: 10.3748/wjg.15.5326

AIM: To ascertain the usefulness of a histological scoring system devised to assist in the interpretation of liver histology in neonatal cholestasis (NC).

METHODS: Liver biopsy specimens obtained from infants with NC referred to a tertiary pediatric unit in Malaysia were prospectively studied. The first author, blinded to the final diagnosis, devised the histological diagnosis based on a 7-feature (portal ductal proliferation, bile plugs in portal ductules, porto-portal bridging, lymphocytic infiltration in portal region, multinucleated hepatocytes, neutrophilic infiltration, hepatocellular swelling), 15-point (0 to 15) scoring system. The author classified the histological diagnosis as either biliary atresia (BA) or neonatal hepatitis (NH, all other diagnoses), and subsequently compared the author's diagnosis with the final diagnosis.

RESULTS: Eighty-four biopsy specimens obtained from 78 patients were reviewed. Without the scoring system, BA was correctly diagnosed by the author histologically in 30 cases, labelled as NH in 3. For other diagnoses, BA was excluded correctly in 33 cases and mislabeled as BA in 2 cases. The overall sensitivity for BA was 91%, specificity 86% and accuracy 88%. With the scoring system, a score of >or=7 had the best diagnostic utility to differentiate BA from other intrahepatic cholestasis histologically (sensitivity 88%, specificity 94%, accuracy 92%). Four patients with a score<7 had BA, and 3 patients with a score>or=7 had NH.

CONCLUSION: A 7-feature, 15-point histological scoring system had good diagnostic accuracy in the interpretation of liver histology in neonatal cholestasis.

Matched MeSH terms: Liver Diseases/pathology
Fulltext Liver Pathology in Rats Treated with Newcastle Disease Virus Strains AF2240 and V4-UPM

Assayaghi RM, Alabsi AM, Swethadri G, Ali AM

Asian Pac J Cancer Prev, 2019 Oct 01;20(10):3071-3075.
PMID: 31653156 DOI: 10.31557/APJCP.2019.20.10.3071

BACKGROUND: Treatment of cancer with chemo-radiotherapy causes severe side effects due to cytotoxic effects towards normal tissues which often results in morbidity. Therefore, developing anticancer agents which can selectively target the cancer cells and cause less side effects are the main objectives of the new therapeutic strategies for treatment advanced or metastatic cancers. Newcastle disease virus strains AF2240 and V4-UPM were shown to be cytolytic against various cancer cells in-vitro and very effective as antileukemicagents.
METHODS: 45 rats at 6 weeks of age, were randomly assigned to nine groups with 5 rats in each group, both azoxymethane (AOM) and 5-Fluorouracil (5-FU) were given to rats according to the body weight. NDV virus strains (AF2240 and V4-UPM) doses were determined to rats according to CD50 resulted from MTT assay. After 8 doses of NDV strians and 5-FU, tissue sections preparations and histopathological study of rats' organs were done.
RESULTS: In this article morphological changes of rats' organs, especially in livers, after treatment with a colon carcinogen (azoxymethane) and Newcastle disease virus strains have been recorded. We observed liver damage caused by AOM evidenced by morphological changes and enzymatic elevation were protected by the oncolytic viruses sections. Also we found that combination treatment NDV with 5-FU had greater antitumor efficacy than treatment with NDV or 5-FU alone.
CONCLUSION: We noted morphological changes in liver and other rats' organs due to a chemical carcinogen and their protection by NDV AF2240 and NDV V4-UPM seems to be most protective.

Matched MeSH terms: Liver Diseases/pathology*
Fulltext Hepatoprotective Effects of Morinda citrifolia Leaf Extract on Ovariectomized Rats Fed with Thermoxidized Palm Oil Diet: Evidence at Histological and Ultrastructural Level

Chong CLG, Hussan F, Othman F

Oxid Med Cell Longev, 2019;2019:9714302.
PMID: 31827717 DOI: 10.1155/2019/9714302

Morinda citrifolia (Rubiaceae) or Noni was previously reported to have leaf with broad therapeutic property whereas the fruit was rarely described as medicinal. Ironically, extensive research and review has been done on the fruit and little was known about the therapeutic activity of the leaf as a medicinal food. The aim of this study was to investigate the therapeutic effects of Morinda citrifolia (MC) ethanolic leaf extract on the hepatic structure and function in postmenopausal rats fed with thermoxidized palm oil (TPO) diet. Thirty eight female Sprague Dawley rats were divided into five groups: sham (Sham), ovariectomized (OVX), ovariectomized and treated with simvastatin 10 mg/kg (OVX+ST), ovariectomized and supplemented with low dose MC 500 mg/kg (OVX+MCLD), and ovariectomized and supplemented with high dose MC 1000 mg/kg (OVX+MCHD). All the ovariectomized groups were fed with TPO diet whereas the Sham group was fed with normal diet. Consumption of TPO diet in postmenopausal rats resulted in obesity, significantly elevated (P < 0.05) liver oxidative stress marker; malondialdehyde (MDA), diffuse microvesicular steatosis, and defective mitochondria. Treatment with MC leaf extract prevented hepatic steatosis by significantly increasing (P < 0.05) the liver antioxidant enzyme SOD and GPx, significantly increasing (P < 0.05) ALP, decreasing liver lipids infiltration, preventing mitochondrial damage, and overall maintaining the normal liver histology and ultrastructure. In conclusion, we provided detailed histological and ultrastructural evidence showing hepatoprotective effects of MC leaf extract through its antioxidant mechanism.

Matched MeSH terms: Liver Diseases/pathology
Malignant transformation of mesenchymal hamartoma of the liver: case report and review of the literature

Ramanujam TM, Ramesh JC, Goh DW, Wong KT, Ariffin WA, Kumar G, et al.

J Pediatr Surg, 1999 Nov;34(11):1684-6.
PMID: 10591570

Here the first case in the literature of both mesenchymal hamartoma and malignant mesenchymoma occurring in a 6-year-old male child, at different times and at different sites in the liver, and also the possible malignant transformation of a mesenchymal hamartoma is reported. The tumor developed from a lesion in the right lobe that was overlooked initially during a left lateral segmentectomy at 18 months of age for a mesenchymal hamartoma. Malignant mesenchymoma is a rare and aggressive tumor. The origin of this tumor is not well understood. There has been no direct support to the hypothesis that malignant mesenchymoma may be the malignant counterpart of mesenchymal hamartoma. The authors provide clinical and histopathologic evidence in our case that suggests the possibility of malignant mesenchymoma arising from a mesenchymal hamartoma. This case emphasizes the need for complete removal of mesenchymal hamartoma and the need for long-term follow-up to detect multifocal lesion or malignant transformation.

Matched MeSH terms: Liver Diseases/pathology*
Neurological disorders in sheep during signal grass (Brachiaria decumbens) toxicity

Abdullah AS, Noordin MM, Rajion MA

Vet Hum Toxicol, 1989 Apr;31(2):128-9.
PMID: 2929118

Severe neurological dysfunction was observed in sheep 4 weeks after grazing on Signal grass (Brachiaria decumbens). These neurological disorders included the stamping of forelegs, star-gazing, incoordination, head-pressing against the fence and circling movements. Histologically, numerous vacuolations of various sizes were observed in the white matter of the brain giving rise to a spongy appearance.

Matched MeSH terms: Liver Diseases/pathology
Fulltext Moringa oleifera hydroethanolic extracts effectively alleviate acetaminophen-induced hepatotoxicity in experimental rats through their antioxidant nature

Fakurazi S, Sharifudin SA, Arulselvan P

Molecules, 2012 Jul 10;17(7):8334-50.
PMID: 22781444 DOI: 10.3390/molecules17078334

The aim of the study was to investigate the in vitro antioxidant properties Moringa oleifera Lam. (MO) extracts and its curative role in acetaminophen (APAP)-induced toxic liver injury in rats caused by oxidative damage. The total phenolic content and antioxidant properties of hydroethanolic extracts of different MO edible parts were investigated by employing an established in vitro biological assay. In the antihepatotoxic study, either flowers or leaves extract (200 mg/kg or 400 mg/kg, i.p) were administered an hour after APAP administration, respectively. N-Acetylcysteine was used as the positive control against APAP-induced hepatotoxicity. The levels of liver markers such as alanine aminotransferase (ALT) and the levels of oxidative damage markers including malondialdehyde (MDA), 4-hydroxynonenal (4-HNE) protein adduct, reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) were analysed and compared between experimental groups. Among MO edible parts the flower extracts contain the highest total phenolic content and antioxidant capacity, followed by leaves extract. The oxidative marker MDA, as well as 4-HNE protein adduct levels were elevated and GSH, SOD and CAT were significantly decreased in groups treated with hepatotoxin. The biochemical liver tissue oxidative markers measured in the rats treated with MO flowers and leaves hydroethanolic extracts showed a significant (p < 0.05) reduction in the severity of the liver damage. The results of this study strongly indicate the therapeutic properties of MO hydroethanolic extracts against acute liver injury and thereby scientifically support its traditional use.

Matched MeSH terms: Liver Diseases/pathology