Alpha-1- antitrypsin globules diastase PAS stain ( from
College of Amer. Pathologists) |
Fig 30 - ALPHA-1-ANTITRYPSIN STORAGE: The periportal hepatocytes contain very visible citoplasmic inclusions
that are diastase resistant PAS positive and can be identified with
immunoperoxidase method as alpa-1-antitrypsin (A1AT) material.
Diastase -PAS stain should be done routinely in liver biopsies.
The inclusions are almost always present in homozygous (ZZ) or
heterozygous (MZ,SZ) phenotypes of A1AT deficiency cases.
Non-alpha-1-antitrypsin similar inclusions are occasinally seen in other
conditions,such as:post mortem material and biopsy material in cirrhosis.
Immunoperoxidase reaction for A1AT will solve the problem.
Fibrinogen storage also may mimic A1AT inclusions.It can be detected
with immunoperoxidase reaction.
|
Glycogen storage
PAS stain
|
Fig 31 - GLYCOGEN STORAGE: On H&E stain the cytoplasm of the hepatocyte is clear and the cell membrane
thick. Also the nucleus may be clear.Both cytoplasm and nucleus will be
intensely positive on PAS stain,epecially in alcohol fixed specimens.
These changes occur in vaious forms of hereditary glycogenosis and in
acquired conditions such as diabetes,primary or induced by steroids.
In diabetes there will be a large number of vacuolated noclei in the periportal
area.Nuclear vacuolization ,however,may be seen without diabetes indicating
that this finding is not diagnostic.It is a meaningless frequent change in
autopsy material.Glycogen nuclei are very numerous and periportal in
Wilson's disease.Since nucear vacuolization occurs at an early
presymptomatic stage of the disease, it cannot be overlooked in a liver biopsy
because it may guide to an early diagnosis and a tempestive treatment.
Glycogen loss is one of the first manifestations of hepatocellular injury. |
Megamytochondria in
alcoholic liver (H&E)
(from G. Klatskin:Histopathology
of the Liver)
|
Fig 32 - MEGAMITOCHONDRIA: With H&E stain they show as round or elongated eosinophilic bodies with sharp
borders ,containing fine granular material.They may be single or multiple and
larger than the nucleus.Must be distinguished from alpha-1-antitrypsin granules
and from Mallory bodies.A1AT are diastase-PAS positive.Mallory bodies have
irregular margins and variable shape. Immunostains for Mallory bodies and for
alpha-1-antitrypsin will be decisive. |
Ground glass cells in a
carrier of B hepatitis
|
Fig 33 - GROUND GLASS HEPATOCYTES (1): Cells with a homogenous cytoplasm similar to ground glass easily spotted on
H&E stain.They are seen most frequently in carrieres of HBV infection where
there is marked accumulation of HBV surface antigen i the endoplasmic reticulum..
Immunostain for HBVsAg will be positive.The ground glass change,however, may
occur in cases treated with various drugs which produce hyperplasia of the
endoplasmic reticulum,such as barbiturates,diazepam,methotraxate, etc
In this instance ,the cells are called induction cells.(2) |