Histological evaluation of extent of disease involvement in non-cirrhotic portal hypertension

Abstract

Background: Non-cirrhotic portal fibrosis (NCPF) is a common cause of variceal bleed and can clinically mimic cirrhosis. Histological evaluation of a liver biopsy can serve multiple purposes. Materials and Methods: Retrieved liver biopsies from 41 patients of diagnosed NCPF and extra-hepatic portal vein obstruction (EHPVO) were included. The histopathological spectrum was compared. Light microscopic fibrosis staging in NCPF was compared with the fibroscan scores and liver fibrosis scores measured by computer assisted image analysis (CIA) technique. The extent of histological findings in portal tracts, and beyond the portal tracts was evaluated. Results: While in NCPF, intra-hepatic portal vein thickening, thrombosis, obliterative portal venopathy (OPV), portal inflammation, peri-portal creeping fibrosis, peri-portal aberrant vascular channels were more frequent, nodular regenerative hyperplasia was common in EHPVO. In the former, fibrosis beyond portal tract was seen in almost one third of cases, however significant fibrosis was not seen in EHPVO. Liver fibrosis grades in NCPF did not correlate with elastogram values, but, correlated well with CIA measured fibrosis scores. Conclusion: Histological evaluation in NCPF can give vital clues about diagnosis in an appropriate clinical setting, exclude cirrhosis and help in optimum fibrosis staging. In NCPF, the pathology is not restricted to portal tracts, but extends beyond them.