101
|
Ennaifer R, Souabni L, Hefaiedh R, Romdhane H, Ben Nejma H, Bel Hadj N. Liver cirrhosis localized in the left lobe: an unusual presentation of small duct primary sclerosing cholangitis. LA TUNISIE MEDICALE 2013; 91:748-750. [PMID: 24458689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
102
|
Abstract
Primary sclerosing cholangitis is the classic hepatobiliary manifestation of inflammatory bowel disease and is generally chronic and progressive. Patients frequently present with asymptomatic, anicteric cholestasis, but many develop progressive biliary strictures with time, leading to recurrent cholangitis, biliary cirrhosis, and end-stage liver disease. Medical treatment does not slow the progression of disease, and many patients need liver transplantation, after which recurrent disease is a risk. The increased incidence of hepatobiliary cancer, which is not related to the underlying severity of biliary fibrosis, is of particular concern. Risk of colorectal cancer is also increased in patients with coexistent inflammatory bowel disease. Mechanistic insights have arisen from studies of secondary sclerosing cholangitis, in which a similar clinical profile is associated with a specific cause, and genomic studies have elucidated potential disease-initiating pathways in the primary form. The close association between inflammatory bowel disease and primary sclerosing cholangitis underscores the need to further understand the role of environmental factors in generation of lymphocytes that are postulated to be retargeted, deleteriously, to the biliary tree. Treatment of primary sclerosing cholangitis is confined to supportive measures, but advances in pathobiology suggest that new stratified approaches will soon be available.
Collapse
|
103
|
Dongiovanni P, Donati B, Fares R, Lombardi R, Mancina RM, Romeo S, Valenti L. PNPLA3 I148M polymorphism and progressive liver disease. World J Gastroenterol 2013; 19:6969-6978. [PMID: 24222941 PMCID: PMC3819533 DOI: 10.3748/wjg.v19.i41.6969] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/06/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
The 148 Isoleucine to Methionine protein variant (I148M) of patatin-like phospholipase domain-containing 3 (PNPLA3), a protein is expressed in the liver and is involved in lipid metabolism, has recently been identified as a major determinant of liver fat content. Several studies confirmed that the I148M variant predisposes towards the full spectrum of liver damage associated with fatty liver: from simple steatosis to steatohepatitis and progressive fibrosis. Furthermore, the I148M variant represents a major determinant of progression of alcohol related steatohepatitis to cirrhosis, and to influence fibrogenesis and related clinical outcomes in chronic hepatitis C virus hepatitis, and possibly chronic hepatitis B virus hepatitis, hereditary hemochromatosis and primary sclerosing cholangitis. All in all, studies suggest that the I148M polymorphism may represent a general modifier of fibrogenesis in liver diseases. Remarkably, the effect of the I148M variant on fibrosis was independent of that on hepatic steatosis and inflammation, suggesting that it may affect both the quantity and quality of hepatic lipids and the biology of non-parenchymal liver cells besides hepatocytes, directly promoting fibrogenesis. Therefore, PNPLA3 is a key player in liver disease progression. Assessment of the I148M polymorphism will possibly inform clinical practice in the future, whereas the determination of the effect of the 148M variant will reveal mechanisms involved in hepatic fibrogenesis.
Collapse
MESH Headings
- Carcinoma, Hepatocellular
- Cholangitis, Sclerosing/enzymology
- Cholangitis, Sclerosing/genetics
- Cholangitis, Sclerosing/pathology
- Disease Progression
- Fatty Liver/complications
- Fatty Liver/enzymology
- Fatty Liver/genetics
- Fatty Liver/pathology
- Fatty Liver, Alcoholic/complications
- Fatty Liver, Alcoholic/enzymology
- Fatty Liver, Alcoholic/genetics
- Fatty Liver, Alcoholic/pathology
- Genetic Predisposition to Disease
- Hemochromatosis/enzymology
- Hemochromatosis/genetics
- Hemochromatosis/pathology
- Hepatitis B, Chronic/enzymology
- Hepatitis B, Chronic/genetics
- Hepatitis B, Chronic/pathology
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/enzymology
- Hepatitis C, Chronic/genetics
- Hepatitis C, Chronic/pathology
- Humans
- Lipase/genetics
- Liver Cirrhosis/enzymology
- Liver Cirrhosis/genetics
- Liver Cirrhosis/pathology
- Liver Cirrhosis, Alcoholic/enzymology
- Liver Cirrhosis, Alcoholic/genetics
- Liver Cirrhosis, Alcoholic/pathology
- Liver Neoplasms/enzymology
- Liver Neoplasms/genetics
- Liver Neoplasms/pathology
- Membrane Proteins/genetics
- Non-alcoholic Fatty Liver Disease
- Phenotype
- Polymorphism, Genetic
- Risk Factors
Collapse
|
104
|
Tabibian JH, Talwalkar JA, Lindor KD. Role of the microbiota and antibiotics in primary sclerosing cholangitis. BIOMED RESEARCH INTERNATIONAL 2013; 2013:389537. [PMID: 24232746 PMCID: PMC3819830 DOI: 10.1155/2013/389537] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/05/2013] [Indexed: 12/18/2022]
Abstract
Primary sclerosing cholangitis (PSC) is an idiopathic, progressive, cholestatic liver disease with considerable morbidity and mortality and no established pharmacotherapy. In addition to the long-recognized association between PSC and inflammatory bowel disease, several lines of preclinical and clinical evidence implicate the microbiota in the etiopathogenesis of PSC. Here we provide a concise review of these data which, taken together, support further investigation of the role of the microbiota and antibiotics in PSC as potential avenues toward elucidating safe and effective pharmacotherapy for patients afflicted by this illness.
Collapse
|
105
|
Singh S, Talwalkar JA. Primary sclerosing cholangitis: diagnosis, prognosis, and management. Clin Gastroenterol Hepatol 2013; 11:898-907. [PMID: 23454027 PMCID: PMC3692584 DOI: 10.1016/j.cgh.2013.02.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/05/2013] [Accepted: 02/06/2013] [Indexed: 02/07/2023]
Abstract
Primary sclerosing cholangitis (PSC) is a chronic immune-mediated disease of the liver of unclear etiology, characterized by chronic inflammation and fibrosis of bile ducts. It primarily affects middle-aged men and is associated with 4-fold increased mortality as compared with an age- and sex-matched population. Progressive biliary and hepatic damage results in portal hypertension and hepatic failure in a significant majority of patients over a 10- to 15-year period from the initial diagnosis. In addition, PSC confers a markedly increased risk of hepatobiliary cancer, including cholangiocarcinoma and gallbladder cancer, as compared with the general population, and cancer is the leading cause of mortality in patients with PSC. It is associated with inflammatory bowel disease in 70% of patients and increases the risk of colorectal cancer almost 10-fold. Despite significant research efforts in this field, the pathogenic mechanisms of PSC are still incompletely understood, although growing evidence supports the role of genetic and immunologic factors. There are no proven medical therapies that alter the natural course of the disease. Thus, liver transplantation is the only available treatment for patients with advanced PSC, with excellent outcomes in this population.
Collapse
|
106
|
Kimura Y, Yamashita Y, Mikami S, Ono H, Itai R, Matsumoto Y, Yamada S, Takada M, Sumitomo Y. [Eosinophilic cholangitis from almost normal appearance to the bile duct sclerosis similar to primary sclerosing cholangitis]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 2013; 110:271-281. [PMID: 23381216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 48-year-old man was admitted to our hospital because of eosinophilia and liver dysfunction. Initial abdominal CT and MRI (MRCP) finding showed almost normal liver and bile duct. Liver biopsy demonstrated mild portal infiltration of lymphocytes and eosinophils. Definitive diagnosis was difficult, but we suspected autoimmune disease. Oral steroid administration was started, which led to a rapid improvement of eosinophilia and liver dysfunction. Dose reduction of steroid administration resulted in exacerbation of eosinophilia and liver dysfunction. Follow-up MRCP and ERCP study revealed biliary strictures similar to primary sclerosing cholangitis (PSC). A second liver biopsy revealed dense infiltration composed of lymphocytes and eosinophils in the portal area. Therefore we diagnosed eosinophilic cholangitis. This is the first case of eosinophilic cholangitis, observed after changes of the bile duct from an almost normal appearance to diffuse sclerosing and narrowing similar to PSC by imaging and pathological studies.
Collapse
|
107
|
Güngör Ö, Sarsık B, Tatar E, Akarca US, Tekeşin O, Sezak M, Başcı A. Inflammatory bowel disease presenting with nephrotic syndrome and cholestasis. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2013; 24:568-569. [PMID: 24623302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
108
|
Wakai T, Shirai Y, Sakata J, Maruyama T, Ohashi T, Korira PV, Ajioka Y, Hatakeyama K. Clinicopathological features of benign biliary strictures masquerading as biliary malignancy. Am Surg 2012; 78:1388-1391. [PMID: 23265129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Discrimination between benign and malignant biliary strictures is difficult, with 5.2 to 24.5 per cent of biliary strictures proving to be benign after histological examination of the resected specimen. This study aimed to evaluate the clinicopathological features of benign biliary strictures in patients undergoing resection for presumed biliary malignancy. From January 1990 to August 2010, 5 of 153 (3.3%) patients who had undergone resection after a preoperative diagnosis of biliary malignancy had a final histological diagnosis of benign biliary stricture. The infiltration of immunoglobulin G4-positive plasma cells was evaluated by immunohistochemistry. None of the five patients had a history of trauma or earlier hepatobiliary surgery and all five underwent hemihepatectomy (combined with extrahepatic bile duct resection in three patients). Postoperative morbidity was recorded in two patients (transient cholangitis and biliary fistula), but there was no postoperative mortality. Histological re-examination identified immunoglobulin G4-related sclerosing cholangitis (n = 2) and nonspecific fibrosis/inflammation (n = 3). No preoperative clinical or radiographic features were identified that could reliably distinguish patients with benign biliary strictures from those with biliary malignancies. Although benign biliary strictures are rare, differentiating benign strictures from malignancy remains problematic. Thus, the treatment approach for biliary strictures should remain surgical resection for presumed biliary malignancy.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Bile Duct Neoplasms/diagnostic imaging
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/surgery
- Bile Ducts, Intrahepatic/pathology
- Bile Ducts, Intrahepatic/surgery
- Biopsy, Needle
- Cholangiocarcinoma/diagnostic imaging
- Cholangiocarcinoma/pathology
- Cholangiocarcinoma/surgery
- Cholangitis, Sclerosing/diagnostic imaging
- Cholangitis, Sclerosing/pathology
- Cholangitis, Sclerosing/surgery
- Cohort Studies
- Constriction, Pathologic/pathology
- Constriction, Pathologic/surgery
- Databases, Factual
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Hepatectomy/methods
- Humans
- Immunohistochemistry
- Liver Cirrhosis/diagnostic imaging
- Liver Cirrhosis/pathology
- Liver Cirrhosis/surgery
- Male
- Middle Aged
- Retrospective Studies
- Risk Assessment
- Tomography, X-Ray Computed/methods
Collapse
|
109
|
Ngu JH, Gearry RB, Stedman CAM. Has primary sclerosing cholangitis associated with Crohn's disease a better outcome? J Crohns Colitis 2012; 6:956; author reply 957. [PMID: 22677115 DOI: 10.1016/j.crohns.2012.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/18/2012] [Indexed: 02/08/2023]
|
110
|
Sibulesky L, Nguyen J, Patel T. Preneoplastic conditions underlying bile duct cancer. Langenbecks Arch Surg 2012; 397:861-7. [PMID: 22391777 PMCID: PMC3804833 DOI: 10.1007/s00423-012-0943-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 02/22/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Malignancies arising from the biliary tract can arise from the epithelial lining of the biliary tract and surrounding tissues. Conditions that predispose to malignancy as well as preneoplastic changes in biliary tract epithelia have been identified. In this overview, we discuss preneoplastic conditions of the biliary tract and emphasize their clinical relevance. RESULTS Chronic biliary tract inflammation predisposes to cancer in the biliary tract. Biliary tract carcinogenesis involves a multistep process as a consequence of chronic biliary epithelial injury or inflammation. Reminiscent of other gastrointestinal epithelial malignancies such as gastric, colon, and pancreatic cancer, biliary tract cancers may evolve via multistep progression from epithelial hyperplasia and dysplasia to malignant transformation. The potential role of initiating cells is also becoming recognized. CONCLUSIONS In spite of improved risk factor recognition, and advances in diagnostic tools, the early diagnosis of pre-malignant or malignant biliary tract conditions is extremely challenging, and there is a paucity of evidence on which to base their management. As a result, the role of pre-emptive surgery remains largely undefined.
Collapse
|
111
|
Ovchinsky N, Moreira RK, Lefkowitch JH, Lavine JE. Liver biopsy in modern clinical practice: a pediatric point-of-view. Adv Anat Pathol 2012; 19:250-62. [PMID: 22692288 PMCID: PMC3404724 DOI: 10.1097/pap.0b013e31825c6a20] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Liver biopsy remains the foundation of evaluation and management of liver disease in children, although the role of the liver biopsy is changing with development of alternative methods of diagnosis and advancement of hepatic imaging techniques. The indications for liver biopsy are evolving as current knowledge of etiologies, noninvasive biomarker alternatives, and treatment options in pediatric liver disease are expanding. The procedure can often be complicated in children by technical difficulties, cost, and smaller specimen size. Communication and partnership of clinicians with pathologists experienced in pediatric liver diseases are essential. DNA sequencing, novel imaging modalities, noninvasive biomarkers of fibrosis and apoptosis, proteomics, and genome-wide association studies offer potential alternative methods for evaluation of liver disease in children. This review presents specific indications, considerations, methods, complications, contraindications, and alternatives for pediatric liver biopsy.
Collapse
|
112
|
Kawa S, Watanabe T, Maruyama M, Ito T, Muraki T, Hamano H, Arakura N. [Extra-pancreatic lesions of autoimmune pancreatitis and diagnostic procedures]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 2012; 109:897-904. [PMID: 22688165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
113
|
Hirabayashi K, Zamboni G. IgG4-related disease. Pathologica 2012; 104:43-55. [PMID: 22953500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
IgG4-related disease (IgG4-RD) is considered a fibro-inflammatory condition with a marked propensity to form mass forming lesions, characterized by a dense lymphoplasmacytic infiltrate, the presence of abundant IgG4+ plasma cells, frequent elevation of serum IgG4 and a dramatic initial response to glucocorticoid. Nowadays, IgG4-RD has been described in almost every organ system: the pancreatobiliary tract, liver, salivary glands, nasopharynx, bone marrow, lacrimal gland, extra-ocular muscles and retrobulbar space, kidneys, lungs, lymph nodes, meninges, aorta and arteries, skin, breast, prostate, thyroid gland and pericardium. Although the common diagnostic features of all these regional involvements cannot be defined with certainty, and slight differences have been noted in different organs, many histopathological features are shared. Consensus has not yet been reached regarding criteria that have to be fulfilled for a new IgG4-RD. The proposed criteria include appropriate clinical and histopathological findings, presence of abundant tissue-infiltrating IgG4+ plasma cells, high serum IgG4 concentrations, response to steroid therapy, other autoimmune diseases or other organ involvement. The two hallmark features for diagnosis are histopathological characteristics and the presence of infiltrating IgG4+ plasma cells. In this review, we will focus on the histopathological features of IgG4-RD in specific organs and discuss the relationship with inflammatory pseudotumour and malignancy, IgG4 counting methods, and diagnosis using biopsy specimens. IgG4-related disease (IgG4-RD) is a multi-organ system disease that has been recognized in the last 10 years. IgG4-RD has a marked propensity to present as mass-forming lesions. The two hallmark features for diagnosis are histopathological characteristics and the presence of infiltrating IgG4+ plasma cells. Correct identification is crucial to avoid unnecessary major surgical procedures and initiate corticosteroid therapy.
Collapse
|
114
|
Reinhard L, Rupp C, Riedel HD, Ruppert T, Giese T, Flechtenmacher C, Weiss KH, Kloeters-Plachky P, Stremmel W, Schirmacher P, Sauer P, Gotthardt DN. S100A9 is a biliary protein marker of disease activity in primary sclerosing cholangitis. PLoS One 2012; 7:e29821. [PMID: 22253789 PMCID: PMC3256182 DOI: 10.1371/journal.pone.0029821] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/06/2011] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIMS Bile analysis has the potential to serve as a surrogate marker for inflammatory and neoplastic disorders of the biliary epithelium and may provide insight into biliary pathophysiology and possible diagnostic markers. We aimed to identify biliary protein markers of patients with primary sclerosing cholangitis (PSC) by a proteomic approach. METHODS Bile duct-derived bile samples were collected from PSC patients (n = 45) or patients with choledocholithiasis (n = 24, the control group). Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was performed to analyse the proteins, 2-D-gel patterns were compared by densitometry, and brush cytology specimens were analysed by RT-PCR. RESULTS A reference bile-duct bile proteome was established in the control group without signs of inflammation or maligancy comprising a total of 379 non-redundant biliary proteins; 21% were of unknown function and 24% had been previously described in serum. In PSC patients, the biliary S100A9 expression was elevated 95-fold (p<0.005), serum protein expression was decreased, and pancreatic enzyme expression was unchanged compared to controls. The S100A9 expression was 2-fold higher in PSC patients with high disease activity than in those with low activity (p<0.05). The brush cytology specimens from the PSC patients with high disease activity showed marked inflammatory activity and leukocyte infiltration compared to the patients with low activity, which correlated with S100A9 mRNA expression (p<0.05). CONCLUSIONS The bile-duct bile proteome is complex and its analysis might enhance the understanding of cholestatic liver disease. Biliary S100A9 levels may be a useful marker for PSC activity, and its implication in inflammation and carcinogenesis warrants further investigation.
Collapse
|
115
|
Miao XP, Sun XN, Wei H, Ouyang Q. Crohn's disease and primary sclerosing cholangitis: a case report and review of the literature. Intern Med 2012; 51:2077-81. [PMID: 22892482 DOI: 10.2169/internalmedicine.51.7583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The comorbidity of Crohn's disease (CD) and primary sclerosing cholangitis (PSC) is uncommon. Diagnosing such patients can be difficult, as illustrated by the following case. The combination of CD and PSC should be considered in patients with CD who have abnormal liver function. Because patients with PSC often present asymptomatically, all patients with CD should be screened for PSC by checking serum liver tests. Review of the literature suggests that there is an increased potential in these patients for the development of malignancy and long-term prognosis is poor. We conclude that patients diagnosed with a combination of CD and PSC should be managed with periodic colonoscopy, CA 19-9 investigation, early liver and bowel imaging, and liver biopsy. The treatment of CD associated with PSC remains unsatisfactory and the possibility of liver transplantation should be considered.
Collapse
|
116
|
Kevans D, Greene J, Galvin L, Morgan R, Murray FE. Mesalazine-induced bronchiolitis obliterans organizing pneumonia (BOOP) in a patient with ulcerative colitis and primary sclerosing cholangitis. Inflamm Bowel Dis 2011; 17:E137-8. [PMID: 21761513 DOI: 10.1002/ibd.21819] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 06/08/2011] [Indexed: 01/29/2023]
|
117
|
Naitoh I, Zen Y, Nakazawa T, Ando T, Hayashi K, Okumura F, Miyabe K, Yoshida M, Nojiri S, Kanematsu T, Ohara H, Joh T. Small bile duct involvement in IgG4-related sclerosing cholangitis: liver biopsy and cholangiography correlation. J Gastroenterol 2011; 46:269-76. [PMID: 20821235 DOI: 10.1007/s00535-010-0319-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 08/16/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND IgG4-related sclerosing cholangitis (IgG4-SC) needs to be differentiated from primary sclerosing cholangitis (PSC). In this study, we performed a retrospective study to reveal cases in which liver needle biopsy was useful for differential diagnosis. METHODS Nineteen patients with IgG4-SC and 22 patients with PSC were studied. All patients underwent endoscopic retrograde cholangiography and liver needle biopsy. We defined small bile duct involvement of IgG4-SC histologically as damage to the small bile duct associated with infiltration of ≥10 IgG4+ plasma cells per high power field (HPF). Clinicopathological characteristics were compared between IgG4-SC patients with and without small bile duct involvement. RESULTS Small bile duct involvement was observed in 5 (26%) of the patients with IgG4-SC. Patients with small bile duct involvement showed a higher incidence of intrahepatic biliary strictures on cholangiography (80 vs. 21%, p = 0.038). Conversely, 4 of 7 (57%) patients with intrahepatic biliary strictures on cholangiography had histologically evident small duct involvement. The number of IgG4+ plasma cells was significantly correlated with the site of the most proximal stricture on cholangiograms (p = 0.021). The number of IgG4+ plasma cells per HPF was significantly higher in IgG4-SC patients with intrahepatic biliary strictures than in those with PSC (13.4 vs. 0.4 cells/HPF, p < 0.001). CONCLUSIONS Involvement of small bile ducts is more frequent in patients with intrahepatic biliary strictures on cholangiography, and liver needle biopsy is especially useful for these patients.
Collapse
|
118
|
Liaskou E, Karikoski M, Reynolds GM, Lalor PF, Weston CJ, Pullen N, Salmi M, Jalkanen S, Adams DH. Regulation of mucosal addressin cell adhesion molecule 1 expression in human and mice by vascular adhesion protein 1 amine oxidase activity. Hepatology 2011; 53:661-72. [PMID: 21225644 PMCID: PMC3031027 DOI: 10.1002/hep.24085] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 11/08/2010] [Indexed: 01/06/2023]
Abstract
UNLABELLED Primary sclerosing cholangitis (PSC) and autoimmune hepatitis are hepatic complications associated with inflammatory bowel disease (IBD). The expression of mucosal addressin cell adhesion molecule 1 (MAdCAM-1) on mucosal endothelium is a prerequisite for the development of IBD, and it is also detected on the hepatic vessels of patients with liver diseases associated with IBD. This aberrant hepatic expression of MAdCAM-1 results in the recruitment of effector cells initially activated in the gut to the liver, in which they drive liver injury. However, the factors responsible for the aberrant hepatic expression of MAdCAM-1 are not known. In this study, we show that deamination of methylamine (MA) by vascular adhesion protein 1 (VAP-1) [a semicarbazide-sensitive amine oxidase (SSAO) expressed in the human liver] in the presence of tumor necrosis factor α induces the expression of functional MAdCAM-1 in hepatic endothelial cells and in intact human liver tissue ex vivo. This is associated with increased adhesion of lymphocytes from patients with PSC to hepatic vessels. Feeding mice MA, a constituent of food and cigarette smoke found in portal blood, led to VAP-1/SSAO-dependent MAdCAM-1 expression in mucosal vessels in vivo. CONCLUSION Activation of VAP-1/SSAO enzymatic activity by MA, a constituent of food and cigarette smoke, induces the expression of MAdCAM-1 in hepatic vessels and results in the enhanced recruitment of mucosal effector lymphocytes to the liver. This could be an important mechanism underlying the hepatic complications of IBD.
Collapse
|
119
|
Strnad P, Schwarz P, Rasenack MCD, Kucukoglu O, Habib RI, Heuberger D, Ehehalt R, Müller MW, Stiehl A, Adler G, Kulaksiz H. Hepcidin is an antibacterial, stress-inducible peptide of the biliary system. PLoS One 2011; 6:e16454. [PMID: 21283681 PMCID: PMC3025980 DOI: 10.1371/journal.pone.0016454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 12/20/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS Hepcidin (gene name HAMP), an IL-6-inducible acute phase peptide with antimicrobial properties, is the key negative regulator of iron metabolism. Liver is the primary source of HAMP synthesis, but it is also produced by other tissues such as kidney or heart and is found in body fluids such as urine or cerebrospinal fluid. While the role of hepcidin in biliary system is unknown, a recent study demonstrated that conditional gp130-knockout mice display diminished hepcidin levels and increased rate of biliary infections. METHODS Expression and localization of HAMP in biliary system was analyzed by real time RT-PCR, in-situ hybridization, immunostaining and -blotting, while prohepcidin levels in human bile were determined by ELISA. RESULTS Hepcidin was detected in mouse/human gallbladder and bile duct epithelia. Biliary HAMP is stress-inducible, in that it is increased in biliary cell lines upon IL-6 stimulation and in gallbladder mucosa of patients with acute cholecystitis. Hepcidin is also present in the bile and elevated prohepcidin levels were observed in bile of primary sclerosing cholangitis (PSC) patients with concurrent bacterial cholangitis compared to PSC subjects without bacterial infection (median values 22.3 vs. 8.9; p = 0.03). In PSC-cholangitis subjects, bile prohepcidin levels positively correlated with C-reactive protein and bilirubin levels (r = 0.48 and r = 0.71, respectively). In vitro, hepcidin enhanced the antimicrobial capacity of human bile (p<0.05). CONCLUSION Hepcidin is a stress-inducible peptide of the biliary epithelia and a potential marker of biliary stress. In the bile, hepcidin may serve local functions such as protection from bacterial infections.
Collapse
|
120
|
Andraus W, Haddad L, Nacif LS, Silva FD, Blasbalg R, D'Albuquerque LAC. The best approach for diagnosing primary sclerosing cholangitis. Clinics (Sao Paulo) 2011; 66:1987-9. [PMID: 22086533 PMCID: PMC3203975 DOI: 10.1590/s1807-59322011001100022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
121
|
Abstract
IgG4-related systemic disease is a recently described entity that can elude even the most astute diagnostician. Patients with the disease, characterized by the infiltration of polyclonal IgG4-positive plasmacytes, can present with single or multi-organ involvement. Manifestations include dacryoadenitis, sialadenitis, thyroiditis, pneumonitis, retroperitoneal fibrosis, pancreatitis, sclerosing cholangitis, tubulointerstitial nephritis, prostatitis, and hypophysitis. We describe a biopsy-confirmed case with extensive multi-organ involvement, including hypophysitis, dacryoadenitis, retroperitoneal fibrosis and tubulointerstitial nephritis. By reporting this case, we hope to bring IgG4-related systemic disease to the attention of the broader medical community as it is an elusive disease that commonly responds to systemic corticosteroids.
Collapse
|
122
|
Kawakami H, Zen Y. Is IgG4 immunostaining of duodenal ampullary biopsies alone useful to diagnose autoimmune pancreatitis? Gastrointest Endosc 2010; 72:1328; author reply 1328-9. [PMID: 21111884 DOI: 10.1016/j.gie.2010.03.1132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 03/30/2010] [Indexed: 12/10/2022]
|
123
|
Abstract
Autoimmune hepatitis does not have a pathognomonic feature, and its laboratory, serologic, and histologic manifestations are shared with a variety of acute and chronic liver diseases. The disease has active and quiescent phases and thus variable histologic appearances. This article outlines the many histologic faces of autoimmune hepatitis. It discusses the fulminant and acute forms, as well as the chronic hepatitic forms. Overlap syndromes with primary biliary cirrhosis and primary sclerosing cholangitis are described. The role of the pathologist in reporting the biopsies is discussed.
Collapse
|
124
|
Lauridsen MEM, Mortensen FV, Nielsen DT, Grønbæk H. Creation of a fistula between the hepatic duct and the gastric lumen by way of percutaneus transhepatic cholangiography: a case report. J Gastrointest Cancer 2010; 43:354-7. [PMID: 20862565 DOI: 10.1007/s12029-010-9212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cholangiocellular carcinoma accounts for 3% of gastrointestinal tumors. It is the second most common primary hepatic malignancy and is associated with primary sclerosing cholangitis. CASE DESCRIPTION We report a patient with primary sclerosing cholangitis and cholangiocellular carcinoma who underwent partial hepatectomy and postoperatively suffered life-threatening biliary stasis with cholascos and peritonitis. The patient had cholangiocellular carcinoma recurrence at the resection margins and local lymph node metastases, but chemotherapy was not possible because of elevated bilirubin and liver dysfunction. After successful percutaneous stenting and placement of an internal-external drainage tube from the biliary tree to the gastric ventricle, ascites and cholascos resolved completely and the patient was then referred for chemotherapy. The internal-external drainage tube was converted to an internal tube after 3 1/2 months. The patient received chemotherapy and survived 14 months after stenting. DISCUSSION Preferably, bile leaks should be detected preoperatively but the ongoing development of solutions to the postoperative biliary complications seen in these patients is extremely important.
Collapse
|
125
|
Honsová E, Lodererová A, Kostolná E, Oliverius M. [Autoimmune pancreatitis with biliary tree and liver involvement as a part of IgG4-related autoimmune sclerosing disease. Case report]. CESKOSLOVENSKA PATOLOGIE 2010; 46:65-67. [PMID: 20941960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report a rare case of autoimmune pancreatitis associated with sclerosing cholangitis, kidney, and salivary glands involvement. Abdominal ultrasound and CT scan showed enlarged pancreas, multiple nodular mass in the liver and kidney. ERCP showed features compatible with primary sclerosing cholangitis. The working clinical diagnosis considered malignant tumor with liver metastases. Histological examination of the liver biopsy sample revealed inflammatory process with numerous IgG4 positive plasma cells. The diagnostic conclusion of IgG4-related autoimmune sclerosing disease was drawn. The serum IgG level was elevated. Treatment with steroids improved the clinical course, all masses in the liver and kidneys disappeared, and laboratory tests were normalized. Now, 4 years after diagnosis the patient is free of all symptoms.
Collapse
|