Quantitative analysis of ductus proliferation, proliferative activity, Kupffer cell proliferation and angiogenesis in differential diagnosis of biliary atresia and neonatal hepatitis.

ABSTRACT

BACKGROUND/AIMS: The clinical presentation of cholestasis in infancy caused by neonatal hepatitis and biliary atresia are very similar. Differential diagnosis is sometimes very difficult. The diagnostic accuracy is very important. The surgical treatment of biliary atresia should be performed as early as possible. If cases of biliary atresia are misdiagnosed, they will become progressive cirrhosis and if cases of neonatal hepatitis are misdiagnosed, they will result in unnecessary laparotomy. The aim of this study is to determine the role of quantitative analysis of ductus proliferation, proliferative activity, Kupffer cell proliferation and angiogenesis in the differential diagnosis of biliary atresia and neonatal hepatitis. METHODOLOGY: This study included 60 infants, 30 with neonatal hepatitis and 30 with biliary atresia. Differential diagnosis was done by ultrasonography, cholescintigraphy and liver biopsy. The parafifin-embedded tissue sections of liver biopsies underwent immunohistochemistry with Ki67 to mark proliferation activity, cytokeratin to mark the proliferating ductuli, vimentin to mark Kupffer cells, and CD34 to mark capillary vessels. Number of ductuli per high power field, number of Ki-67 positive cells per ductus, number of Kupffer cells per high power field and number of capillary vessels per high power field were calculated. Independent T test was used for statistical evaluation. RESULTS: Independent sample T test indicated that there is a significant difference for proliferating ductuli and proliferation activity between neonatal hepatitis and biliary atresia. Biliary atresia cases represent more proliferating ductuli and proliferation activity in ductal epithelial cells than neonatal hepatitis cases. There is no statistical significance for Kupffer cell proliferation and vascularization. CONCLUSIONS: Our results indicate that, quantitative analysis of proliferating ductuli and proliferation activity of ductal epithelial cells may be helpful in differential diagnosis of neonatal hepatitis and biliary atresia. Besides neither Kupffer cell proliferation nor vascularization are found to be useful in differential diagnosis.