Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
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Original Article

Volume 13, Number 1, February 2020, pages 32-39

Histologic Lesions of Porto-Sinusoidal Vascular Disease Following Phlebotomy in Hemochromatosis


Figure 1.
Figure 1. Representative images of histologic features evaluated. (a) Shunt vessels (*) herniating into the liver parenchyma (Masson’s trichrome, × 200). (b) Increased number of portal vessels: multiple portal vein branches (*) are present in a portal tract (hematoxylin and eosin (H&E), × 200). (c) Obliterative portal venopathy (H&E, × 300). (d) Rudimentary portal tract: hypoplastic portal tract in which the lumen of the bile duct is smaller than the diameter of the surrounding hepatocytes (Masson’s trichrome, × 300). (e) Central vein clustering (H&E, × 100). (f) Sinusoidal dilatation (H&E, × 200). (g) Incomplete fibrous septa (Masson’s trichrome, × 100). (h) Anisocytosis (H&E, × 200).


Table 1. Histological Features of Liver Biopsies and Definition [10, 20]
Histological featuresDefinition
aThe presence/absence of each feature was documented.
Portal tract changes
  P1: Portal inflammationPresence of mononuclear cells with or without interface activitya
  P2: Bile ductular proliferationMultiple bile ductules in a portal tracta
  P3: Shunt vessel (periportal)Portal venous branches communicating with and herniating into the surrounding liver parenchymaa
  P4: Increased number of portal vesselsMultiple portal vein branches in a portal tracta
  P5: Obliterative portal venopathyPhlebosclerosis; partial or complete obliteration of the portal venous lumena
  P6: Rudimentary portal tractHypoplastic portal tract in which the lumen of the bile duct is smaller than the diameter of the surrounding hepatocytesa
Lobular changes
  L1: Central vein clusteringIncreased central veins per lobule, arbitrarily defined as four or more CVs per lobule at medium (× 10) magnificationa
  L2: Sinusoidal dilatationDilated sinusoidsa
  L3: Iron granularityThe magnifications at which the granules are seen (naked eye, × 2, × 4, × 10, × 20, × 40)
  L4: Iron zonationLocalization of iron granules: zone 1, zone 2 or zone 3
  L5: Incomplete septaThin fibrous septum arising from a portal tract blindly ending in the lobulea
  L6: Perisinusoidal fibrosisFibrosis of zone 3 sinusoidsa
  L7: FibrosisMETAVIR fibrosis stage: F1, F2, F3, F4
  L8: AnisocytosisSize variation in hepatocytes as a surrogate for nodular regenerationa
Total number of portal tracts in the sample
Features of fatty liver disease (> 5% of steatosis and ballooning degeneration)


Table 2. Summary of Results
VariablePre-phlebotomy (N = 22)Post-phlebotomy (N = 29)P value
aMean length of biopsy core and number of portal tracts were evaluated in biopsy specimens without cirrhosis and tumor. bStudent’s t-test. cFisher’s exact test. CS: combined score; F3 and F4: METAVIR fibrosis stage F3 and F4; PSVD: porto-sinusoidal vascular disease; SV: shunt vessel.
Mean length of biopsy corea2.5 cm2.6 cm
Mean number of portal tractsa1214
Iron index8.34.30.010b
CS of vascular changes3.34.00.160b
CS (cases with advanced fibrosis (F3, F4) excluded)3.6 (n = 14)4.8 (n = 21)0.029b
CS (cases with risk factors for PSVD further excluded)3.6 (n = 9)4.8 (n = 18)0.034b
High-grade SV (≥ 50% of portal tracts with SV, excluding cases with advanced fibrosis)7% (n = 14)38% (n = 21)0.056c
Coexisting fatty liver disease64%48%> 0.05c