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Histological Pattern and Outcome of Filipino Children with Liver Disease Who Underwent Percutaneous Liver Biopsy: A Five Year Survey
Judy Lyn D. Vitug,1 Jose Ma. C. Avila2 and Germana V. Gregorio1
1Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics,
College of Medicine and Philippine General Hospital, University of the Philippines Manila
2Department of Pathology, College of Medicine, University of the Philippines Manila
Background. Histological assessment is imporant in evaluating liver disease. We determine the clinical diagnoses and predominant histological patterns of children with liver disease and association of histological pattern with outcome.
Methods. Consecutive patients <19 years who had liver biopsy were included. Clinical diagnoses were determined. Histological assessment was done using nine patterns to describe histopathologic changes. Outcome was assessed at least 6 months after diagnosis.
Results. 470 cases (1month-18years; 65% males; 85% <1year) were included. Most common clinical diagnoses were neonatal hepatitis (49%) and biliary atresia (29%). 229 neonatal hepatitis with giant cell pattern had better outcome (96% alive after 1 year vs 136 biliary atresia with obstructive/ fibrotic pattern of whom 74% died, p= <0.05). In the other disorders namely Alagille's syndrome, bile duct abnormalities, liver tumor and both chronic hepatitis and portal vein thrombosis, the predominant histologies were bile duct paucity, fibrotic, neoplastic and near normal patterns, respectively. In these cases, association with outcome could not be done due to limited patients.
Conclusion. Most common clinical diagnoses were neonatal hepatitis and biliary atresia. Predominant histological patterns were giant cell and obstructive type. Histological pattern of gitant cell hepatitis seen in neonatal hepatitis resulted in better outcome.
Key Words: histopathologic pattern, liver biopsy, neonatal hepatitis, biliary atresia