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Denk H, Pabst D, Abuja PM, Reihs R, Tessaro B, Zatloukal K, Lackner C. Senescence markers in focal nodular hyperplasia of the liver: pathogenic considerations on the basis of immunohistochemical results. Mod Pathol 2022; 35:87-95. [PMID: 34645984 DOI: 10.1038/s41379-021-00940-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Abstract
Focal nodular hyperplasia (FNH) is a polyclonal tumour-like hepatic lesion characterised by parenchymal nodules, connective tissue septa without interlobular bile ducts, pronounced ductular reaction and inflammation. It may represent a response to local arterial hyperperfusion and hyperoxygenation resulting in oxidative stress. We aimed at obtaining closer insight into the pathogenesis of FNH with its characteristic morphologic features. Immunohistochemistry and immunofluorescence microscopy was performed on FNH specimens using antibodies against keratins (K) 7 and 19, neural cell adhesion molecule (NCAM), lamin B1, senescence markers (CDK inhibitor 1/p21Cip1, CDK inhibitor /p16Ink4a, senescence-associated (SA) β- galactosidase activity), proliferation markers (Ki-67, proliferating-cell nuclear antigen (PCNA)), and the abnormally phosphorylated histone γ-H2AX, indicating DNA double strand breaks; moreover SA β- galactosidase activity was determined histochemically. Ductular metaplasia of hepatocytes indicated by K7 expression in the absence of K19 plays a major role in the development of ductular reaction in FNH. Moreover, the expression of senescence markers (p21Cip1, p16Ink4a, γ-H2AX, SA β-galactosidase activity) in hepatocytes and cholangiocytes suggests that stress-induced cellular senescence contributes to fibrosis and inflammation via production of components of the senescence-associated secretory phenotype. Expression of proliferation markers (Ki-67, PCNA) was not enhanced in hepatocytes and biliary cells. Senescence and ductular metaplasia of hepatocytes may thus be involved in inflammation, fibrosis and apoptosis resistance. Hence, fibrosis, inflammation and reduced apoptotic cell death, rather than proliferation (hyperplasia) may be responsible for increased tissue mass and tumour-like appearance of FNH.
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Affiliation(s)
- Helmut Denk
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria.
| | - Daniela Pabst
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Peter M Abuja
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Robert Reihs
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Brigitte Tessaro
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kurt Zatloukal
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Carolin Lackner
- Diagnostic & Research Centre of Molecular Biomedicine, Institute of Pathology, Medical University of Graz, Graz, Austria
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Ductal plates in hepatic ductular reactions. Hypothesis and implications. III. Implications for liver pathology. Virchows Arch 2011; 458:271-9. [PMID: 21301864 DOI: 10.1007/s00428-011-1050-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/18/2011] [Accepted: 01/20/2011] [Indexed: 02/08/2023]
Abstract
This article discusses on the basis of the ductal plate hypothesis the implication of the concept for several liver abnormalities. The occurrence of ductal plates (DP) during liver growth in childhood would explain the paraportal and parenchymal localizations of von Meyenburg complexes in postnatally developed parts of the liver, and their higher incidence in adulthood versus childhood. It partly clarifies the lack of postnatal intrahepatic bile duct development in Alagille syndrome and the reduced number of portal tracts in this disease. Ductular reactions (DRs) in DP configuration are the predominant type of progenitor cell reaction in fulminant necro-inflammatory liver disease, when lack of sufficient parenchymal regeneration results in liver failure. The concept of dissecting DRs explains the micronodular pattern of advanced biliary and alcoholic cirrhosis. The concept explains the DP patterns of bile ducts in several cases of biliary atresia, with implications for diagnosis and prognosis. The hypothesis also has an impact on concepts about stem/progenitor cells and their niche.
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Desmet VJ. Ductal plates in hepatic ductular reactions. Hypothesis and implications. III. Implications for liver pathology. Virchows Arch 2011; 458:251-9. [PMID: 21301864 DOI: 10.1007/s00428-011-1048-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 01/18/2011] [Accepted: 01/20/2011] [Indexed: 01/09/2023]
Abstract
This article discusses on the basis of the ductal plate hypothesis the implication of the concept for several liver abnormalities. The occurrence of ductal plates (DP) during liver growth in childhood would explain the paraportal and parenchymal localizations of von Meyenburg complexes in postnatally developed parts of the liver, and their higher incidence in adulthood versus childhood. It partly clarifies the lack of postnatal intrahepatic bile duct development in Alagille syndrome and the reduced number of portal tracts in this disease. Ductular reactions (DRs) in DP configuration are the predominant type of progenitor cell reaction in fulminant necro-inflammatory liver disease, when lack of sufficient parenchymal regeneration results in liver failure. The concept of dissecting DRs explains the micronodular pattern of advanced biliary and alcoholic cirrhosis. The concept explains the DP patterns of bile ducts in several cases of biliary atresia, with implications for diagnosis and prognosis. The hypothesis also has an impact on concepts about stem/progenitor cells and their niche.
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Affiliation(s)
- Valeer J Desmet
- Department of Pathology, University Hospital K.U.Leuven, Leuven, Belgium,
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Venturi A, Piscaglia F, Vidili G, Flori S, Righini R, Golfieri R, Bolondi L. Diagnosis and management of hepatic focal nodular hyperplasia. J Ultrasound 2007; 10:116-27. [PMID: 23396642 PMCID: PMC3478711 DOI: 10.1016/j.jus.2007.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign tumor of the liver, after hemangioma. It is generally found incidentally and is most common in reproductive-aged women, but it also affects males and can be diagnosed at any age. Patients are rarely symptomatic, but FNH sometimes causes epigastric or right upper quadrant pain. The main clinical task is to differentiate it from other hypervascular hepatic lesions such as hepatic adenoma, hepatocellular carcinoma, or hypervascular metastases, but invasive diagnostic procedures can generally be avoided with the appropriate use of imaging techniques. Magnetic resonance (MR) imaging is more sensitive and specific than conventional ultrasonography (US) or computed tomography (CT), but Doppler US and contrast-enhanced US (CEUS) can greatly improve the accuracy in the diagnosis of FNH. Once a correct diagnosis has been made, in most cases there is no indication for surgery, and treatment includes conservative clinical follow-up in asymptomatic patients.
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Affiliation(s)
- A. Venturi
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - F. Piscaglia
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - G. Vidili
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - S. Flori
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - R. Righini
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - R. Golfieri
- Department of Radiology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
| | - L. Bolondi
- Department of Internal Medicine and Gastroenterology, Policlinico St. Orsola-Malpighi, University of Bologna, Italy
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Fischer HP, Zhou H. Leberparenchymknoten bei pathologischer hepatischer Vaskularisation/Perfusion. DER PATHOLOGE 2006; 27:273-83. [PMID: 16773311 DOI: 10.1007/s00292-006-0839-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nodular regenerative hyperplasia (NRH) is characterized by a non-cirrhotic micronodular transformation of the liver parenchyma. It is based on the obliteration of small portal veins. Macroregenerative nodules (MRN) develop in areas of favourable blood flow in otherwise hypoperfused liver tissue. Hypoperfusion is caused by obliteration of liver veins and/or large portal veins with the subsequent atrophy or extinction of parenchyma. The hyperperfused and sometimes rapidly growing MRN might simulate a malignant tumor in CT and MRT. Morphologically, MRN resemble FNH. In contrast to hepatocellular adenoma, they show a more or less nodular architecture with fibrous septa and ductular structures. NRH and cases of MRN without cirrhosis can indicate an extrahepatic/systemic disease causing altered liver perfusion. MRN in liver cirrhosis must be differentiated from dysplastic nodules and highly differentiated hepatocellular carcinoma by cytological and microarchitectural criteria. Focal nodular hyperplasia (FNH) can imitate liver cirrhosis, steatohepatitis, cholangitis or chronic hepatitis, if biopsy material does not include normal perilesional liver tissue. Telangiectatic FNH might resemble classic hepatocellular adenoma. Neoductular structures and septation argue for this rare subtype of FNH. Neoductular transformation of hypoperfused liver parenchyma might imitate cholangioma or cholangiocarcinoma.
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Affiliation(s)
- H-P Fischer
- Institut für Pathologie, Universität Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn.
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Gütgemann I, Haas S, Berg JP, Zhou H, Büttner R, Fischer HP. CD56 expression aids in the differential diagnosis of cholangiocarcinomas and benign cholangiocellular lesions. Virchows Arch 2006; 448:407-11. [PMID: 16411132 DOI: 10.1007/s00428-005-0145-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 12/07/2005] [Indexed: 11/28/2022]
Abstract
CD56 (neuronal cell adhesion molecule, N-CAM) has been reported in neuroendocrine tumours and as a marker of reactive biliary epithelial cells. However, up to date, it is not used to distinguish malignant from non-malignant biliary lesions. In this study, we systematically examined CD56 expression on 98 tumours arising from the biliary tree as well as intrahepatic conditions with reactive neoductules. When neuroendocrine carcinomas are excluded, only 4 of 32 (12.5%) cholangiocarcinomas expressed CD56, 2 of which showed clear cell morphology. Reactive bile ductules adjacent to cirrhotic nodules as well as in focal nodular hyperplasia were CD56 positive. Twelve of 17 (70.5%) bile duct adenomas were CD56 positive, whereas von Meyenburg complexes expressed CD56 only very focally in less than 5% of lesional cells. Bile duct cysts were negative for CD56 with the exception of focally interspersed neuroendocrine cells, similar to that seen in segmental bile ducts. Thus, if van Meyenburg complexes are excluded, CD56 can be used to differentiate intrahepatic non-neoplastic from neoplastic proliferations, which is a helpful diagnostic tool in small liver biopsies.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/metabolism
- Adenoma, Bile Duct/diagnosis
- Adenoma, Bile Duct/metabolism
- Bile Duct Neoplasms/diagnosis
- Bile Duct Neoplasms/metabolism
- Bile Ducts, Extrahepatic/metabolism
- Bile Ducts, Extrahepatic/pathology
- Bile Ducts, Intrahepatic/metabolism
- Bile Ducts, Intrahepatic/pathology
- Biomarkers, Tumor/metabolism
- CD56 Antigen/metabolism
- Cholangiocarcinoma/diagnosis
- Cholangiocarcinoma/metabolism
- Cholangitis/metabolism
- Cholangitis/pathology
- Choledochal Cyst/diagnosis
- Choledochal Cyst/metabolism
- Cystadenoma, Mucinous/diagnosis
- Cystadenoma, Mucinous/metabolism
- Diagnosis, Differential
- Humans
- Immunohistochemistry
- Liver Cirrhosis/diagnosis
- Liver Cirrhosis/metabolism
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Affiliation(s)
- I Gütgemann
- Institute of Pathology, University of Bonn, Bonn, Germany.
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Lepreux S, Desmouliere A, Rosenbaum J, Balabaud C, Bioulac-Sage P. Expression of fibrillin-1 in focal nodular hyperplasia of the liver: a role in microcirculation adaptability. COMPARATIVE HEPATOLOGY 2004; 3 Suppl 1:S57. [PMID: 14960209 PMCID: PMC2409448 DOI: 10.1186/1476-5926-2-s1-s57] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction It has been suggested that the elastic network plays an important role in the tissue response to mechanical stress. The components of the elastic network have been poorly studied in liver diseases. Therefore, in this work, the expression and distribution of fibrillin-1 and elastin were studied in hepatic focal nodular hyperplasia and compared with surrounding liver and hepatocellular adenoma. Methods Immunohistochemical studies for fibrillin-1 and elastin were performed on unfixed cryostat sections of focal nodular hyperplasia (22 cases), hepatocellular adenoma (15 cases) and surrounding liver (34 cases). Results Surrounding normal liver showed only a continuous, thin and regular immunostaining of fibrillin-1 in the space of Disse, whereas elastin was nearly absent. In focal nodular hyperplasia, fibrillin-1 was more strongly expressed in the perisinusoidal space, compared with surrounding liver; in contrast, in adenomas fibrillin-1 immunostaining was irregular and very low in perisinusoidal space, more intense in peliotic areas. Conclusions In focal nodular hyperplasia, the increased microfibrillar network containing fibrillin-1 in the space of Disse could reflect an adaptation of the sinusoidal wall to an increased arterial blood flow in sinusoids. In hepatocellular adenoma, the different patterns of fibrillin-1 could be related to the heterogeneity of the arterial vascularization and to the frequent necrotico-hemorrhagic changes. This study comparing the elastic network in two types of lesions with vascularization abnormalities and in the surrounding liver provides interesting new data for understanding the structural role of fibrillin-1 in the space of Disse.
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Affiliation(s)
- Sébastien Lepreux
- GREF, INSERM E0362, Université Victor Segalen Bordeaux 2, France
- Service d'Anatomie Pathologique, Hépital Pellegrin, C.H.U. Bordeaux, France
| | | | - Jean Rosenbaum
- GREF, INSERM E0362, Université Victor Segalen Bordeaux 2, France
| | - Charles Balabaud
- GREF, INSERM E0362, Université Victor Segalen Bordeaux 2, France
- Service d'Hépatologie-Gastroentérologie, Hépital Saint-André, C.H.U. Bordeaux, France
| | - Paulette Bioulac-Sage
- GREF, INSERM E0362, Université Victor Segalen Bordeaux 2, France
- Service d'Anatomie Pathologique, Hépital Pellegrin, C.H.U. Bordeaux, France
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Nguyen BN, Fléjou JF, Terris B, Belghiti J, Degott C. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol 1999; 23:1441-54. [PMID: 10584697 DOI: 10.1097/00000478-199912000-00001] [Citation(s) in RCA: 257] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Atypical histologic variants of focal nodular hyperplasia have been reported and are sometimes difficult to recognize. To characterize the morphologic spectrum of focal nodular hyperplasia, we studied 305 lesions surgically resected from 168 patients. Clinicomorphologic correlations were established by statistical analyses. The patients included 150 women and 18 men (sex ratio, 8:1; median age, 38 years). One hundred twenty-eight (76.2%) patients had solitary lesions, and 40 (23.8%) had 2 to 30 lesions. All 305 lesions measured 1 mm to 19 cm in diameter. Only 49% of these lesions had one to three macroscopic scars. Histologically, 245 (80.3%) lesions were of classical form, and 60 (19.7%) lesions were nonclassical. The latter were classified as focal nodular hyperplasia of telangiectatic form (47 lesions), of mixed hyperplastic and adenomatous form (five lesions), and with atypia of large cell type (eight lesions). Several benign or malignant tumors were found in association with these lesions. This large retrospective series of focal nodular hyperplasia shows the relative incidence of its classical and nonclassical forms. The absence of a central scar could explain the difficult preoperative diagnosis of some of the cases. The morphologic diagnostic criteria in this study require further prospective evaluation.
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Affiliation(s)
- B N Nguyen
- Department of Anatomic Pathology, Beaujon Hospital, Clichy, France
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Fukukura Y, Nakashima O, Kusaba A, Kage M, Kojiro M. Angioarchitecture and blood circulation in focal nodular hyperplasia of the liver. J Hepatol 1998; 29:470-5. [PMID: 9764996 DOI: 10.1016/s0168-8278(98)80067-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND/AIMS We sought to clarify important unresolved points regarding angioarchitecture and blood circulation in focal nodular hyperplasia. METHODS Twenty-nine surgically resected focal nodular hyperplasia lesions were examined histologically, immunohistochemically, and radiologically. In three autopsy cases, red- and blue-colored gelatin was injected into the hepatic artery and the portal vein, respectively, to demonstrate the vasculature in focal nodular hyperplasia. RESULTS Histologically, no orientation with respect to portal tracts and central veins was evident in any lesion. Within lesions, vessels were classified as: (i) anomalous arteries in the fibrous septa, (ii) capillaries in the fibrous septa, or (iii) venous vessels located mainly in the parenchyma. Vessels and sinusoids adjacent to fibrous septa were stained for CD 34 and von Willebrand factor. The anomalous arteries were connected to the capillaries. Capillaries in the fibrous septa were connected to sinusoids adjacent to fibrous septa. Venous vessels were connected to central or hepatic veins surrounding the lesions. Intranodular sinusoids were connected to the sinusoids in the surrounding normal liver. Red-colored gelatin, injected at autopsy into the hepatic artery, appeared not only in the anomalous arteries but also in capillaries and in sinusoids adjacent to the fibrous septa of the lesion. Angiography clearly depicted hepatic veins located near the lesions in nine cases. Computed tomography during arterial portography disclosed no portal blood flow in the lesions. CONCLUSIONS In focal nodular hyperplasia, arterial blood flows from the anomalous arteries via the capillaries into sinusoids adjacent to fibrous septa. The blood in the sinusoids drained to the hepatic vein either directly or via perinodular sinusoids.
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Affiliation(s)
- Y Fukukura
- The First Department of Pathology, Kurume University School of Medicine, Fukuoka, Japan
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Abstract
When red deer (Cervus elaphus) were hunted by humans with hounds the average distance travelled was at least 19 km. This study of 64 hunted red deer provides the first empirical evidence on their state at the time of death. Blood and muscle samples obtained from hunted deer after death were compared with samples from 50 non-hunted red deer that had been cleanly shot with rifles. The effects on deer of long hunts were (i) depletion of carbohydrate resources for powering muscles, (ii) disruption of muscle tissue, and (iii) elevated secretion of beta-endorphin. High concentrations of cortisol, typically associated with extreme physiological and psychological stress, were found. Damage to red blood cells occurred early in the hunts; possible mechanisms are discussed. Taken together, the evidence suggests that red deer are not well-adapted by their evolutionary or individual history to cope with the level of activity imposed on them when hunted with hounds.
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Affiliation(s)
- P Bateson
- Sub-Department of Animal Behaviour, University of Cambridge, UK
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Meybehm M, Fischer HP, Pfeifer U. Expression of HBs- and HBc-antigen in neoductular epithelium in chronic active hepatitis B. A further support for hepato-ductular metaplasia. VIRCHOWS ARCHIV. B, CELL PATHOLOGY INCLUDING MOLECULAR PATHOLOGY 1993; 63:167-72. [PMID: 8097073 DOI: 10.1007/bf02899257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Biopsy specimens (n = 61) from patients with chronic active hepatitis B and progressive fibrosis (n = 61) were studied immunohistochemically to obtain information about the histogenesis of neoductules. All the biopsies contained clusters of oval-shaped cells often arranged in the form of neoductular aggregates. These expressed cytokeratins 7 and 19 which in the normal liver are found only in bile duct and ductular epithelium but not in hepatocytes. Using monoclonal and polyclonal antibodies both hepatocytes and these oval neoductular cells were found to express HBs- and HBc-antigen in 15% and 20% of the biopsies, respectively. Taking into consideration the strong hepatocytotropism of the hepatitis B virus, the expression of HBV-antigens in neoductular cells suggest their development from HBV-infected hepatocytes. Using proliferating cell nuclear antigen (PCNA) as a marker of cell proliferation positive staining was detected only in hepatocytes but not in neoductular cells. Taken together findings further support the concept of hepatoductular metaplasia in the histogenesis of so-called "proliferating" ductules. In general the data show that hepatitis B virus infection does not prevent hepatocytes from undergoing ductular metaplasia.
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Affiliation(s)
- M Meybehm
- Department of Pathology, University of Bonn, Germany
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