Pediatric Liver Biopsy: A clinicopathologic study
Keywords:
Liver, Biopsy, Pediatric
Abstract
Introduction – The spectrum of liver diseases in children differs from that in adults. Different diagnostic modalities which are available are not capable of diagnosing the liver disease individually unless they are supplemented by a liver biopsy. Hence liver biopsy is an invaluable tool in the diagnosis of liver diseases.The aims of this study were to study the spectrum of liver diseases in pediatric age group at our institute, to correlate the liver biopsy findings with clinical findings and laboratory investigations and to review the literature on this topic.Results – We received a total of 130 liver biopsies during the five year study. Out of these, 65 biopsies were performed in children below one year of age while the remaining 65 liver biopsies belonged to children aged more than one year. The common indications for performing liver biopsies included prolonged jaundice, clay colored stools, abdominal distension, abdominal pain, suspected inborn error of metabolism and for a suspected hepatic tumor. Extrahepatic biliary atresia was the commonest pathology found in children below one year of age whereas metabolic disease was the most common pathology found in children above one year of age. Special stains helped in refining the diagnosis further. Laboratory investigations were correlated to offer a complete diagnosis.Conclusion – Paediatric liver biopsy is of value in diagnosis of disorders where clinical and laboratory parameters overlap. At the same time, clinical and laboratory correlation is a must due to overlapping histologic features of many liver diseases. DOI: 10.21276/APALM.1220References
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13. Alvarez G, Wang H L. The Liver. In: Humphrey P A, Dehner L P, Pfeifer J D, editors. The Washington Manual of Surgical Pathology, first edition. Wolters Kluwer: Lippincott Wiliams and Wikins;2010. 210-11.
14.Tannapfel A, Dienes HP, Lohse AW: The indications for liver biopsy. Dtsch Arztebl Int 2012; 109: 477–83.
15. Mieli-Vergani G, Heller S, Jara P, et al. Autoimmune Hepatitis. JPGN 2009;49:158–164.
16. Jiménez-Rivera C , Ling SC , Ahmed N. Incidence and Characteristics of Autoimmune Hepatitis. Pediatrics 2015;136:e1238-48.
17. Dehghani S, Haghighat M, Imanieh M, et al. Autoimmune Hepatitis in Children: Experiences in a Tertiary Center. Iran J Pediatr 2013; 23:302-8.
18. Krawitt EL. Clinical features and management of autoimmune hepatitis. World J Gastroenterol. 2008;14 : 3301-5.
19. Monajemzadeh M, Haghi M, Najafi M, et al. Granulomatous hepatitits : A 10 year study in Iranian children. Research journal of biological sciences 2009;4:503-5.
20. Roberts EA, Schilsky ML. Diagnosis and Treatment of Wilson Disease: An Update. Hepatology 2008;47:2089-111.
2. Marion AW, Baker A J, Dhawan A. Fatty liver disease in children. Arch Dis Child. 2004;89:648–52.
3. Muthuphei M N. Childhood liver diseases in Ga- Rankuwa hospital, South Africa. East Afr Med J 2000 ;77:508-509.
4. Chardot C. Biliary atresia. Orphanet Journal of Rare Diseases 2006 ;1:1-9.
5. Hicks J, Mani H, Stocker J T.The Liver, Gallbladder, and Biliary Tract. In: Husain AN,Stocker J T, Dehner L P, editors. Pediatric Pathology. 4th edition. Wolters Kluwer; 2015.640-742.
6.Kahn E. Biliary atresia revisited. Pediatr Dev Pathol. 2004 ;7:109-24.
7. Shah I, Bhatnagar S, Rangarajan V, Patankar N. Utility of Tc99m-Mebrofenin hepato-biliary scintigraphy (HIDA scan) for the diagnosis of biliary atresia. Trop Gastroenterol. 2012;33:62-4.
8.Torbenson M, Hart J, Westerhoff M, et al. Neonatal giant cell hepatitis: histological and etiological findings. Am J Surg Pathol. 2010;34:1498-503.
9.Gupta L, Bhatnagar V.A study of associated congenital anomalies with biliary atresia. J Indian Assoc Pediatr Surg. 2016;21:10-3
10.Srivastava A. Progressive Familial intrahepatic cholestasis. J Clin Exp Hepatol 2014;4:25-36
11.Pinto RB, Schneider ACR, da Silveira TR. Cirrhosis in children and adolescents: An overview. World J Hepatol 2015;7:392-405.
12. Jia-An Zhu, Bing Hu. Ultrasonography in predicting and screening liver cirrhosis in children: A preliminary study. World J Gastroenterol 2003 ;9:2348-9.
13. Alvarez G, Wang H L. The Liver. In: Humphrey P A, Dehner L P, Pfeifer J D, editors. The Washington Manual of Surgical Pathology, first edition. Wolters Kluwer: Lippincott Wiliams and Wikins;2010. 210-11.
14.Tannapfel A, Dienes HP, Lohse AW: The indications for liver biopsy. Dtsch Arztebl Int 2012; 109: 477–83.
15. Mieli-Vergani G, Heller S, Jara P, et al. Autoimmune Hepatitis. JPGN 2009;49:158–164.
16. Jiménez-Rivera C , Ling SC , Ahmed N. Incidence and Characteristics of Autoimmune Hepatitis. Pediatrics 2015;136:e1238-48.
17. Dehghani S, Haghighat M, Imanieh M, et al. Autoimmune Hepatitis in Children: Experiences in a Tertiary Center. Iran J Pediatr 2013; 23:302-8.
18. Krawitt EL. Clinical features and management of autoimmune hepatitis. World J Gastroenterol. 2008;14 : 3301-5.
19. Monajemzadeh M, Haghi M, Najafi M, et al. Granulomatous hepatitits : A 10 year study in Iranian children. Research journal of biological sciences 2009;4:503-5.
20. Roberts EA, Schilsky ML. Diagnosis and Treatment of Wilson Disease: An Update. Hepatology 2008;47:2089-111.
Published
2017-08-31
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