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J Clin Gastroenterol. 1990 Jun;12(3):357-62.

Semiquantitative assessment of cholestasis and lymphocytic piecemeal necrosis in primary biliary cirrhosis: a histologic and immunohistochemical study.

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  • 1Department of Pathology (II), Kanazawa University School of Medicine, Japan.


Histologic activity of chronic cholestasis and lymphocytic piecemeal necrosis, a characteristic finding of chronic active hepatitis, was examined semiquantitatively in 157 liver biopsy specimens from 122 patients with primary biliary cirrhosis (PBC). Although both of these lesions were usually admixed variably in a single liver specimen, semiquantitative assessment made it possible to classify liver biopsy specimens into four groups: group A, no or minimum cholestatic or hepatitic changes (58 specimens); group B, predominantly cholestatic changes (37 specimens); and group C, predominantly hepatitic changes (54 specimens). Only eight specimens fell into group D, prominent cholestatic as well as hepatitic changes. Serial liver biopsies of specimens within groups B and C showed a persistence of group B- and C-type pathologies, while liver biopsies of group A specimens frequently changed to group B or C. Immunohistochemical studies illustrated that lymphocytic piecemeal necrosis mainly consisted of activated T lymphocytes as seen in chronic active hepatitis. Our data suggest that either of two hepatic parenchymal lesions predominates and persists in each liver biopsy specimen. A high cholestatic score appeared to relate to poor prognoses of the patients and also to the degree of cirrhotic transformation. This grouping system may be valuable in the clinicopathologic assessment of PBC, when it is combined with ordinary staging.

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