PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of jclinpathJournal of Clinical PathologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
J Clin Pathol. 1989 November; 42(11): 1160–1165.
PMCID: PMC501974

Portal lymphadenopathy associated with lipofuscin in chronic cholestatic liver disease.

Abstract

To determine whether portal lymphadenopathy in primary biliary cirrhosis is caused by deposition of lipofuscin pigment in sinus histiocytes and to compare primary biliary cirrhosis with other liver diseases a retrospective study on a consecutive series of 169 livers obtained at transplantation was carried out. There were grouped into eight diagnostic categories: primary biliary cirrhosis (n = 51), primary sclerosing cholangitis (n = 10), extrahepatic biliary atresia (n = 6), chronic rejection (n = 9), cirrhosis (other causes) (n = 38), primary liver neoplasia (n = 21), acute liver disease (n = 20), and retransplantation (other) (n = 14). Lymph nodes were present in 66 specimens. Fifty of these contained granules of lipofuscin pigment. The highest incidence of lymph node enlargement and the largest amounts of pigment were present in cases of primary biliary cirrhosis. A similar pattern of lymph node enlargement was also commonly observed in other chronic cholestatic conditions (primary sclerosing cholangitis, biliary atresia, chronic rejection). Much less pigment was seen in nodes draining livers with non-cholestatic cirrhosis or primary tumours. Nodes were not found in acute liver disease. It is concluded that portal lymphadenopathy associated with lipofuscin is a common finding in various chronic cholestatic liver diseases. The pathogenesis of this lesion is uncertain. Most cases are asymptomatic with enlarged nodes which may be detected only at laperotomy or necropsy and may be wrongly attributed to neoplastic disease. Diagnostically, the finding of large amounts of lipofuscin in enlarged portal lymph nodes is a good indicator of underlying chronic cholestatic liver disease.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • SHERLOCK S. Primary billiary cirrhosis (chronic intrahepatic obstructive jaundice). Gastroenterology. 1959 Nov;37:574–586. [PubMed]
  • Benbow EW, McMahon RF. Chromolipid-induced portal lymphadenopathy in primary biliary cirrhosis. Histopathology. 1987 Sep;11(9):971–977. [PubMed]
  • Hubscher SG, Clements D, Elias E, McMaster P. Biopsy findings in cases of rejection of liver allograft. J Clin Pathol. 1985 Dec;38(12):1366–1373. [PMC free article] [PubMed]
  • Hull AR, Atkins CR, Brinker KR, Dawidson I, Dickerman RM, Emerson W, Helderman JH, Levitz B, Long DL, Nesser D, et al. Dallas experience with cyclosporine A (CsA) one to six months posttransplant. Transplant Proc. 1986 Apr;18(2 Suppl 1):128–131. [PubMed]
  • Hübscher SG, Adams DH, Buckels JA, McMaster P, Neuberger J, Elias E. Massive haemorrhagic necrosis of the liver after liver transplantation. J Clin Pathol. 1989 Apr;42(4):360–370. [PMC free article] [PubMed]
  • Witting C, Gross U. Ultrastructural and histochemical investigations of spindle-shaped corpuscles in phagocytic cells of lymph nodes. Beitr Pathol. 1977 Nov;161(3):267–282. [PubMed]
  • Demetris AJ, Jaffe R, Starzl TE. A review of adult and pediatric post-transplant liver pathology. Pathol Annu. 1987;22(Pt 2):347–386. [PubMed]
  • Williams JW, Vera S, Peters TG, Van Voorst S, Britt LG, Dean PJ, Haggitt R, Massie JD. Cholestatic jaundice after hepatic transplantation. A nonimmunologically mediated event. Am J Surg. 1986 Jan;151(1):65–70. [PubMed]
  • Hunter RL, Ferguson DJ, Coppleson LW. Survival with mammary cancer related to the interaction of germinal center hyperplasia and sinus histiocytosis in axillary and internal mammary lymph nodes. Cancer. 1975 Aug;36(2):528–539. [PubMed]
  • Fisher ER, Redmond C, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol no. 4). VI. Discriminants for five-year treatment failure. Cancer. 1980 Aug 15;46(4 Suppl):908–918. [PubMed]
  • Fisher ER, Kotwal N, Hermann C, Fisher B. Types of tumor lymphoid response and sinus histiocytosis. Relationship to five-year, disease-free survival in patients with breast cancer. Arch Pathol Lab Med. 1983 May;107(5):222–227. [PubMed]
  • Taubold RD. Studies on chemical nature of lipofusion (age pigment) isolated from normal human brain. Lipids. 1975 Jul;10(7):383–390. [PubMed]
  • GOMORI G. Histochemistry of human esterases. J Histochem Cytochem. 1955 Nov;3(6):479–484. [PubMed]
  • Goldfischer S, Villaverde H, Forschirm R. The demonstration of acid hydrolase, thermostable reduced diphosphopyridine nucleotide tetrazolium reductase and peroxidase activities in human lipofuscin pigment granules. J Histochem Cytochem. 1966 Sep;14(9):641–652. [PubMed]
  • Salaspuro M, Sipponen P. Demonstration of an intracellular copper-binding protein by orcein staining in long-standing cholestatic liver diseases. Gut. 1976 Oct;17(10):787–790. [PMC free article] [PubMed]
  • Jain S, Scheuer PJ, Archer B, Newman SP, Sherlock S. Histological demonstration of copper and copper-associated protein in chronic liver diseases. J Clin Pathol. 1978 Aug;31(8):784–790. [PMC free article] [PubMed]
  • Nakanuma Y, Karino T, Ohta G. Orcein positive granules in the hepatocytes in chronic intrahepatic cholestasis. Morphological, histochemical and electron X-ray microanalytical examination. Virchows Arch A Pathol Anat Histol. 1979 May 14;382(1):21–30. [PubMed]
  • Guarascio P, Yentis F, Cevikbas U, Portmann B, Williams R. Value of copper-associated protein in diagnostic assessment of liver biopsy. J Clin Pathol. 1983 Jan;36(1):18–23. [PMC free article] [PubMed]
  • Goldfischer S, Moskal J. Electron probe microanalysis of liver in Wilson's disease. Simultaneous assay for copper and for lead deposited by acid phosphatase activity in lysosomes. Am J Pathol. 1966 Feb;48(2):305–315. [PubMed]
  • Goldfischer S, Sternlieb I. Changes in the distribution of hepatic copper in relation to the progression of Wilson's disease (hepatolenticular degeneration). Am J Pathol. 1968 Dec;53(6):883–901. [PubMed]
  • Goldfischer S, Popper H, Sternlieb I. The significance of variations in the distribution of copper in liver disease. Am J Pathol. 1980 Jun;99(3):715–730. [PubMed]
  • Summerfield JA, Elias E, Hungerford GD, Nikapota VL, Dick R, Sherlock S. The biliary system in primary biliary cirrhosis. A study by endoscopic retrograde cholangiopancreatography. Gastroenterology. 1976 Feb;70(2):240–243. [PubMed]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Group