The role of morphological examination and laboratory methods in the diagnosis of autoimmune hepatitis
https://doi.org/10.34680/2076-8052.2023.4(133).587-598
Abstract
The article discusses the issues of diagnosing autoimmune hepatitis and the importance of timely liver biopsy with histological examination. Due to the lack of specific diagnostic markers and vast heterogeneity of clinical, laboratory and histological features, and also considering relatively rare incidence of the disease, the diagnosis of autoimmune hepatitis can be difficult. Therefore, this review summarises the etiopathogenesis, clinical, serological and histological manifestations of autoimmune hepatitis. Special attention is paid to the different specificity of morphological features such as portal hepatitis, centrilobular necroses, rosette formation, emperipolesis and their significance depending on the presence of laboratory signs of autoimmune hepatitis. Visual examples of morphological manifestations are presented. The article also emphasises the importance of a comprehensive approach to signs and symptoms for the detection of autoimmune hepatitis and differential diagnosis with other liver pathologies: viral hepatitis, drug-induced liver injury, primary cholangitis, and Wilson's disease. Consideration of all available data is crucial in the diagnosis of autoimmune hepatitis.
About the Authors
Yе. Yе. Rumyantsev
Yaroslav-the-Wise Novgorod State University
Russian Federation
Russian Federation
Veliky Novgorod
I. A. Strikanov
Yaroslav-the-Wise Novgorod State University
Russian Federation
Russian Federation
Veliky Novgorod
References
1. Tanaka A. Autoimmune hepatitis: 2019 update // Gut and Liver. 2020. 14(4). 430-438. DOI: 10.5009/gnl19261
2. Sandler Yu. G., Vinnitskaya E. V., Alexandrova E. N., Homeriki S. G., Saliev K. G. Diagnostika i lecheniye autoimmunnogo gepatita v usloviyakh statsionarnykh i poliklinicheskikh uchrezhdeniy [Diagnosis and treatment of autoimmune hepatitis in inpatient and polyclinic institutions]. Moscow, 2022. 37 p.
3. You Z., Li Y., Wang Q., Zhao Z., Li Y., Qian Q., Li B., Zhang J., Huang B., Liang J., Chen R., Lyu Z., Chen Y., Lian M., Xiao X., Miao Q., Fang J., Lian Z., Gershwin M. E., Tang R., Ma X. The clinical significance of hepatic CD69+ CD103+ CD8+ resident‐memory T cells in autoimmune hepatitis // Hepatology. 2021. 74(2). 847-863. DOI: 10.1002/hep.31739
4. Floreani A., Restrepo-Jiménez P., Secchi M. F., Martin S. De, Leung P. S. C., Krawitt E., Bowlus C. L., Gershwin M. E., Anaya J.-M. Etiopathogenesis of autoimmune hepatitis // Journal of autoimmunity. 2018. 95. 133-143. DOI: 10.1016/j.jaut.2018.10.020
5. Tsyrkunov V. M., Prokopchik N. I., Andreev V. P. Autoimmunnyy gepatit: morfologicheskiye aspekty [Autoimmune hepatitis: morphological aspects] // Hepatology and gastroenterology. 2021. 5(1). 5-16. DOI: 10.25298/2616-5546-2021-5-1-5-16
6. Takahashi H., Zeniya M. Acute presentation of autoimmune hepatitis: Does it exist? A published work review // Hepatology Research. 2011. 41(6). 498-504. DOI: 10.1111/j.1872-034X.2011.00808.x
7. Zachou K., Muratori P., Koukoulis G. K., Granito A., Gatselis N., Fabbri A., Dalekos G. N., Muratori L. Review article: autoimmune hepatitis–current management and challenges // Alimentary pharmacology & therapeutics. 2013. 38(8). 887-913. DOI: 10.1111/apt.12470
8. Yasui S., Fujiwara K., Yonemitsu Y., Oda S., Nakano M., Yokosuka O. Clinicopathological features of severe and fulminant forms of autoimmune hepatitis // Journal of gastroenterology. 2011. 46(3). 378-390. DOI: 10.1007/s00535-010-0316-3
9. EASL clinical practice guidelines: autoimmune hepatitis. European Association for the Study of The Liver // Journal of hepatology. 2015. 63(4). 971-1004. DOI: 10.1016/j.jhep.2015.06.030
10. Gatselis N. K., Zachou K., Koukoulis G. K., Dalekos G. N. Autoimmune hepatitis, one disease with many faces: etiopathogenetic, clinico-laboratory and histological characteristics // World journal of gastroenterology. 2015. 21(1). 60-83. DOI: 10.3748/wjg.v21.i1.60
11. Covelli C., Sacchi D., Sarcognato S., Cazzagon N., Grillo F., Baciorri F., Fanni D., Cacciatore M., Maffeis V., Guido M. Pathology of autoimmune hepatitis // Pathologica. 2021. 113(3). 185-193. DOI: 10.32074/1591-951X-241
12. Gurung A., Assis D. N., McCarty T. R., Mitchell K. A., Boyer J. L., Jain D. Histologic features of autoimmune hepatitis: a critical appraisal // Human Pathology. 2018. 82. 51-60. DOI: 10.1016/j.humpath.2018.07.014
13. Hofer H., Oesterreicher C., Wrba F., Ferenci P., Penner E. Centrilobular necrosis in autoimmune hepatitis: a histological feature associated with acute clinical presentation // Journal of clinical pathology. 2006. 59(3). 246-249. DOI: 10.1136/jcp.2005.029348
14. Verdonk R. S., Lozano M. F., van den Berg A. P., Gouw A. S. H. Bile ductal injury and ductular reaction are frequent phenomena with different significance in autoimmune hepatitis // Liver International. 2016. 36(9). 1362-1369. DOI: 10.1111/liv.13083
15. Suzuki A., Brunt E. M., Kleiner D. E., Miquel R., Smyrk T. C., AndradeR. J., Lucena M. I., Castiella A., Lindor K., Björnsson E. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug‐induced liver injury // Hepatology. 2011. 54(3). 931-939. DOI: 10.1002/hep.24481
16. Kamar N., Rostaing L., Izopet J. Hepatitis E virus infection in immunosuppressed patients: natural history and therapy // Seminars in liver disease. 2013. 33(1). 62-07. DOI: 10.1055/s-0033-1338115
17. Balitzer D., Shafizadeh N., Peters M. G., Ferrell L. D., Alshak N., Kakar S. Autoimmune hepatitis: review of histologic features included in the simplified criteria proposed by the international autoimmune hepatitis group and proposal for new histologic criteria // Modern Pathology. 2017. 30(5). 773-783. DOI: 10.1038/modpathol.2016.267
18. Huster D. Wilson disease // Der Gastroenterologe. 2018. 13(3). 199-214.
Review
For citations:
Rumyantsev Y.Y., Strikanov I.A. The role of morphological examination and laboratory methods in the diagnosis of autoimmune hepatitis. Title in english. 2023;(4(133)):587-598. (In Russ.) https://doi.org/10.34680/2076-8052.2023.4(133).587-598
Views:
73
Email this article 