Kupffer Cell Hyaline Globules in Children With Autoimmune Hepatitis

Autoimmune hepatitis: clinicopathological characteristics and histopathological diagnosis in the light of current views

The diagnosis of autoimmune hepatitis (AIH) is based on clinical criteria and histopathological findings. Interpretation of lesions observed in liver biopsy specimens, in cases of suspected AIH, requires correlation with clinical data and communication between hepatologists and pathologists. The diagnostic criteria have been modified over the years, and the latest guidelines were proposed in 2022. Implementation of the current recommendations improves diagnostic accuracy for autoimmune hepatitis and related pathologies. This article presents the clinicopathological characteristics of AIH and an overview of the histopathological diagnostic approach in the light of the modern guidelines.

Comparison of four histological scoring systems for autoimmune hepatitis to improve diagnostic sensitivity

BACKGROUND/AIMS

The histological criteria in the 1999 and 2008 scoring systems proposed by the International Autoimmune Hepatitis Group (IAIHG) have their inherent limitations in diagnosing autoimmune hepatitis (AIH). In this study, we evaluated the histology components of four scoring systems (1. revised original scoring system ["1999 IAIHG"], 2. simplified scoring system ["2008 IAIHG"], 3. modified histologic criteria ["2017 UCSF"], and 4. a new histologic criteria proposed by the International AIH Pathology Group ["2022 IAHPG"]) in AIH patients.

METHODS

Medical records and liver biopsies were retrospectively reviewed for 68 patients from two independent medical institutions, diagnosed with AIH based on the 1999 IAIHG system between 2006 and 2016. The histological features were reviewed in detail, and the four histological scoring systems were compared.

RESULTS

Out of the 68 patients, 56 (82.4%) patients met the "probable" or "definite" AIH criteria of the 2008 IAIHG system, and the proportion of histologic score 2 (maximum) was 40/68 (58.8%). By applying the 2017 UCSF criteria, the number of histology score 2 increased to 60/68 (88.2%), and "probable" or "definite" AIH cases increased to 61/68 (89.7%). Finally, applying the 2022 IAHPG histology score resulted in the highest number of cases with histologic score 2 (64/68; 94.1%) and with a diagnosis of "probable" or "definite" AIH (62/68; 91.2%).

CONCLUSION

The recently proposed UCSF/IAHPG histological criteria increased the histology score of AIH. Substituting the histology component of the 2008 IAIHG system with the 2022 IAHPG criteria increased the sensitivity for diagnosing AIH (≥"Probable AIH") from 82.4% to 91.2%.

The many faces and pathologic diagnostic challenges of autoimmune hepatitis

Autoimmune hepatitis (AIH) is an immune-mediated chronic inflammatory liver disease, characterized by hypergammaglobulinemia, the presence of specific autoantibodies, and typical abnormalities in liver histology. Prompt diagnosis and initiation of immunosuppressive treatment are necessary for both chronic and acute onset AIH to prevent progression to end-stage liver disease or fatal liver failure. However, the diagnosis of AIH is challenging mainly because of its heterogeneous clinical, serological and pathological features. Although portal lymphoplasmacytosis and interface hepatitis are the most typical histological features of AIH, many other histological features can be observed in AIH, including emperipolesis, hepatocyte rosettes, and Kupffer cell hyaline globules. Recent studies have questioned emperipolesis and hepatocyte rosette formation as typical features of AIH, and atypical clinical and histological presentations have also been recognized. This led an international working group to propose the modified AIH diagnostic criteria. However, it is well recognized that there are no pathognomonic characteristics that can be used to diagnose AIH and careful clinicopathological correlation is required to arrive at the correct diagnosis. The aim of this review is to summarize the histological features of AIH, its varied histopathologic spectrum, recent updates and major differential diagnoses in routine clinical practice.

Resident macrophages of the lung and liver: The guardians of our tissues

Resident macrophages play a unique role in the maintenance of tissue function. As phagocytes, they are an essential first line defenders against pathogens and much of the initial characterization of these cells was focused on their interaction with viral and bacterial pathogens. However, these cells are increasingly recognized as contributing to more than just host defense. Through cytokine production, receptor engagement and gap junction communication resident macrophages tune tissue inflammatory tone, influence adaptive immune cell phenotype and regulate tissue structure and function. This review highlights resident macrophages in the liver and lung as they hold unique roles in the maintenance of the interface between the circulatory system and the external environment. As such, we detail the developmental origin of these cells, their contribution to host defense and the array of tools these cells use to regulate tissue homeostasis.

Single Channel Image Enhancement (SCIE) of White Blood Cells Based on Virtual Hexagonal Filter (VHF) Designed over Square Trellis

White blood cells (WBCs) are the important constituent of a blood cell. These blood cells are responsible for defending the body against infections. Abnormalities identified in WBC smears lead to the diagnosis of disease types such as leukocytosis, hepatitis, and immune system disorders. Digital image analysis for infection detection at an early stage can help fast and precise diagnosis, as compared to manual inspection. Sometimes, acquired blood cell smear images from an L2-type microscope are of very low quality. The manual handling, haziness, and dark areas of the image become problematic for an efficient and accurate diagnosis. Therefore, WBC image enhancement needs attention for an effective diagnosis of the disease. This paper proposed a novel virtual hexagonal trellis (VHT)-based image filtering method for WBC image enhancement and contrast adjustment. In this method, a filter named the virtual hexagonal filter (VHF), of size 3 × 3, and based on a hexagonal structure, is formulated by using the concept of the interpolation of real and square grid pixels. This filter is convolved with WBC ALL-IBD images for enhancement and contrast adjustment. The proposed filter improves the results both visually and statically. A comparison with existing image enhancement approaches proves the validity of the proposed work.