The use of special stains in liver biopsy interpretation: Implications for the management of liver disease in Nigeria.

Abstract

The evaluation of a liver biopsy requires the use of stains other than routine hematoxylin and eosin (H and E) to highlight many important features. Most Nigerian Histopathology Departments do not routinely perform special stains (personal communication by authors). This study aims to re-evaluate a set of liver biopsies which has been diagnosed solely on H and E stains by performing a standard set of special stains on them. This is a retrospective analysis. The formalin fixed paraffin embedded blocks of liver biopsies reported in two histopathology laboratories between 2008 and 2013 were retrieved. These were stained with H and E and the following standard special stains for liver tissue histology - Perl's Prussian blue, reticulin, Sirius red, Shikata orcein, and periodic acid-Schiff with diastase. The stained slides were re-analyzed. No formal statistical analysis was performed, but results are summarized and tabulated by summary statistics, where appropriate. Seventy-four liver biopsy paraffin blocks were received in the laboratories. Fifty-three (71.6%) were suitable for analysis out of which 51 (68.9%) had their clinical details retrievable. In 29 cases (56.9%), Perl's stain was positive for iron pigment within the hepatocytes with 17 (58.6%) of these being Grade 1, 7 (24.1%) Grade 2, and 5 (17.2%) Grade 3. Shikata orcein revealed hepatitis B viral surface antigen in 15 (29.4%) of the cases while copper-associated protein was demonstrable in 6 (11.8%) of the cases. The discovery of stainable iron implies some degree of disturbance of iron metabolism, and a Grade 3 stainable iron requires investigation for genetic hemochromatosis. The demonstration of copper-associated proteins suggests biliary disease in a noncirrhotic liver which also requires further investigation. This study confirms the need to routinely perform special stains in reporting liver biopsies to fully investigate and manage patients and their relatives.