Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Original Article

Volume 10, Number 3, June 2017, pages 182-189

Histology and Glutamine Synthetase Immunoreactivity in Liver Biopsies From Patients With Congestive Heart Failure

Figures

Figure 1.
Figure 1. Morphologic features seen in congestive hepatopathy, including marked sinusoidal dilatation, centrilobular hepatocellular atrophy and hemorrhage (H&E).
Figure 2.
Figure 2. Examples of liver biopsies with a congestive hepatic fibrosis score 1, central fibrosis (a); score 2A, central zone and portal fibrosis, with accentuation of fibrosis in the central zone (b); score 2B, moderate portal fibrosis and central zone fibrosis, with accentuation of fibrosis in the portal zone (c); score 3, bridging fibrosis (d); score 4, cirrhosis (e) (Masson’s trichrome stain).
Figure 3.
Figure 3. Examples of retained (b) and lost (d) normal perivascular pattern of glutamine synthetase staining (IHC with corresponding H&E - a, c) in congestive hepatopathy.

Tables

Table 1. Features Examined in the Liver Biopsies in This Study
 
Fibrosis stageDefinitionScore/code
No fibrosis0
Central zone fibrosis1
Central zone and mild portal fibrosis, with accentuation at central zone2A
Central zone and mild portal fibrosis, with accentuation at portal zone2B
Bridging fibrosis3
Cirrhosis4
Central zone fibrosis
No fibrosisAbsent
Presence of fibrosisPresent
Sinusoidal dilatation
Normal width of sinusoidsAbsent
Widening of sinusoidsPresent
Centrilobular hemorrhage
Red blood cells confined in sinusoidsAbsent
Red blood cells beyond sinusoidsPresent
Hepatocyte atrophy
Normally sized hepatocytesAbsent
Hepatocyte smaller than normal hepatocytesPresent
Steatosis grade
No steatosisAbsent
(< 5% of biopsy volume)Minimal
(5-33% of biopsy volume)Mild
(34-66% biopsy volume)Moderate
(≥ 67% of biopsy volume)Severe
Cholestasis
No cholestasisAbsent
Cholestasis in hepatocytes, canaliculi, or cholangiolesPresent
Hepatocyte ballooning
No ballooning in any hepatocytesAbsent
Enlarged round hepatocytes with rarefication of cytoplasmPresent
Mallory hyalines
NoAbsent
Any intrahepatocytic ropy eosinophilic filamentsPresent
Ductular proliferation
Normal bile duct profileAbsent
Duct-like structure with or without lumen at the periphery of limiting platePresent
Polymorphonuclear leukocyte inflammation
No neutrophilic inflammationAbsent
Rare neutrophils in the portal tracts and the lobulesPresent
Mononuclear inflammation
No mononuclear inflammationAbsent
Mononuclear inflammatory cells in the sinusoids, portal tracts, or in the lobulesPresent

 

Table 2. Consensus Histologic Characteristics of 36 Liver Biopsies From Patients With Cardiac Hepatopathy
 
N (%)
Stage of fibrosis
  No fibrosis5 (14)
  Centrilobular fibrosis only (1)4 (11)
  Centrilobular (prominent) and portal fibrosis (2A)6 (17)
  Centrilobular and portal (prominent) fibrosis (2B)5 (14)
  Bridging fibrosis (3)6 (17)
  Cirrhosis (4)4 (11)
  Not cirrhosis, but with fibrosis of indeterminate degree6 (17)
Centrilobular fibrosis
  Absent6 (17)
  Present25 (69)
  Indeterminate5 (14)
Sinusoidal dilatation
  Absent8 (22)
  Present26 (72)
  Indeterminate2 (6)
Hepatocyte atrophy
  Absent12 (34)
  Present21 (58)
  Indeterminate3 (8)
Centrilobular hemorrhage
  Absent15 (42)
  Present17 (47)
  Indeterminate4 (11)
Steatosis
  < 5%34 (94)
  5-33%1 (3)
  33-66%0 (0)
  > 66%1 (3)
Ballooning
  Absent35 (97)
  Present1 (3)
Mallory hyalines
  Absent36 (100)
  Present0 (0)
Cholestasis
  Absent35 (97)
  Present1(3)
Lobular polymorphonuclear leukocyte infiltration
  Absent36 (100)
  Present0 (0)
Lobular mononuclear inflammation
  Absent21 (58)
  Present13 (36)
  Indeterminate2 (6)
Portal polymorphonuclear leukocyte infiltration
  Absent35 (97)
  Present1 (3)
Portal mononuclear inflammation
  Absent10 (28)
  Present19 (53)
  Indeterminate7 (19)
Ductular proliferation
  Absent7 (20)
  Present13 (36)
  Indeterminate16 (44)

 

Table 3. Interobserver Agreement on Histopathologic Features of Cardiac Hepatopathy
 
Histologic featureK value (95% CI)Strength of agreement
Sinusoidal dilation (absent/present)0.66 (0.41 - 0.86)Substantial
Centrilobular atrophy (absent/present)0.51 (0.35 - 0.70)Moderate
Centrilobular hemorrhage (absent/present)0.35 (0.19 - 0.53)Fair
Centrilobular fibrosis (absent/present)0.43 (0.21 - 0.68)Moderate
Fibrosis stage (congestive hepatic fibrosis score)0.35 (0.24 - 0.49)Fair
Simplified fibrosis stage (CHFS 0-2B/3-4)0.45 (0.31 - 0.61)Moderate

 

Table 4. Correlation of Histologic Features and GS Staining Pattern in 24 Cases of Histologically Consensus Cardiac Hepatopathy
 
Histologic featureCorrelation coefficientSignificance (P value)
Sinusoidal dilation (absent/present)0.2090.317
Centrilobular atrophy (absent/present)0.0920.66
Centrilobular hemorrhage (absent/present)0.1920.356
Centrilobular fibrosis (absent/present)-0.1260.546
Fibrosis stage (congestive hepatic fibrosis score)0.1070.571