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

Context: 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.Aims: 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.Settings and Design: This is a retrospective analysis.Materials and Methods: 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.Statistical Analysis Used: No formal statistical analysis was performed, but results are summarized and tabulated by summary statistics, where appropriate.Results: 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.Conclusion: This study confirms the need to routinely perform special stains in reporting liver biopsies to fully investigate and manage patients and their relatives.Keywords: Biliary disease, iron overload, liver biopsy, special stain