Wilson disease and its current problems

Clinicopathologic features of Wilson disease of the liver

AIM: To discuss the clinicopathologic features of Wilson disease (WD) of the liver as well as its diagnosis, treatment and prognosis, so as to deepen the understanding of WD and benefit its early diagnosis.

METHODS: Five WD biopsy specimens were examined by HE staining, Masson staining, PAS staining, and rhodanine staining. Cell ultra microstructure observation was enabled by utilizing an electron microscope.

RESULTS: Among the 5 WD cases, 2 were male. The age at first diagnosis was 24 to 47 years, with a mean age of 38 years. Main clinical manifestations included jaundice, liver dysfunction, and Kayser-Fleischer loop indicated by fundus examinations. All patients revealed a serum ceruloplasmin level less than 89.3 mg/L, and light microscopy suggested that 3 of them were chronic severe hepatitis cases with liver fibrosis or cirrhosis, 1 suffered from mild chronic hepatitis and 1 yielded minimal lesions in the hepatic tissue. Rhodamine staining showed deposit of heterogeneous and varying amounts of particles in hepatic cells, especially in those cells located in zone I around portal areas in some cases. Transmission electron microscopy showed Wilson particles with high electron density in the cytoplasm, accompanied with lipid droplets and/or pigmentary granular bodies.

CONCLUSION: Routine laboratory tests, clinical features, as well as histological changes under a light microscope are unspecific in diagnosing WD, whereas Wilson particles detected by transmission electron microscopy can provide an important diagnostic basis for WD. Therefore, liver biopsy is conducive to diagnosis of WD.

Pathogenesis and management of Wilson disease

Hepatolenticular degeneration, commonly known as Wilson disease, is an autosomal recessive inherited disease of abnormal copper metabolism, characterized by the accumulation of copper in the body due to decreased biliary excretion of copper from hepatocytes. Wilson disease protein, ATP7B, functions in copper excretion into bile and in copper secretion to the bloodstream coupled with ceruloplasmin synthesis. Various kinds of mutations of ATP7B cause Wilson disease. Wilson disease is a rare genetic disease that can be treated pharmacologically. Recognition and prompt diagnosis are very important, because Wilson disease is fatal if left untreated. In this review, I summarize the pathogenesis and management of Wilson disease.