The morphological and histopathological assessment of Alagille syndrome with extrahepatic bile duct obstruction: the importance of the differential diagnosis with subgroup "o" biliary atresia.


Journal

Pediatric surgery international
ISSN: 1437-9813
Titre abrégé: Pediatr Surg Int
Pays: Germany
ID NLM: 8609169

Informations de publication

Date de publication:
Sep 2021
Historique:
accepted: 22 05 2021
pubmed: 3 6 2021
medline: 28 9 2021
entrez: 2 6 2021
Statut: ppublish

Résumé

The differential diagnosis between Alagille syndrome (AGS) with extrahepatic bile duct obstruction (EHBDO) and biliary atresia (BA) is difficult. We report a case series of AGS with EHBDO with detailed validation of the morphological and histopathological features for the differential diagnosis of BA. Six liver transplantations (LTs) were performed for AGS with EHBDO. All patients were diagnosed with BA at the referring institution and the diagnosis of AGS was then confirmed based on a genetic analysis before LT. We verified the morphological and histopathological findings of the porta hepatis and liver at the diagnosis of BA and at LT. All patients had acholic stool in the neonatal period and were diagnosed with BA by cholangiography. The gross liver findings included a smooth and soft surface, without any cirrhosis. The gross findings of the porta hepatis included aplasia of the proximal hepatic duct, or subgroup "o", in five patients. The histopathological examination of the EHBD also revealed obstruction/absence of the hepatic duct. There were no patients with aplasia of the common bile duct. Aplasia of the hepatic duct and the macroscopic liver findings may help in to differentiate between AGS with EHBDO and BA.

Identifiants

pubmed: 34076772
doi: 10.1007/s00383-021-04932-z
pii: 10.1007/s00383-021-04932-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1167-1174

Informations de copyright

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Références

Ohashi K, Togawa T, Sugiura T, Ito K, Endo T, Aoyama K et al (2017) Combined genetic analyses can achieve efficient diagnostic yields for subjects with Alagille syndrome and incomplete Alagille syndrome. Acta Paediatr 106(11):1817–1824
doi: 10.1111/apa.13981
Fujishiro J, Suzuki K, Watanabe M, Uotani C, Takezoe T, Takamoto N et al (2018) Outcomes of Alagille syndrome following the Kasai operation: a systematic review and meta-analysis. Pediatr Surg Int 34(10):1073–1077
doi: 10.1007/s00383-018-4316-3
Lin H, Zoll B, Russo P, Spinner NB, Loomes KM (2017) A challenging case of focal extrahepatic duct obstruction/hypoplasia in Alagille syndrome. J Pediatr Gastroenterol Nutr 64(1):e18–e22
doi: 10.1097/MPG.0000000000000563
Subramaniam P, Knisely A, Portmann B, Qureshi SA, Aclimandos WA, Karani JB et al (2011) Diagnosis of Alagille syndrome-25 years of experience at King’s College Hospital. J Pediatr Gastroenterol Nutr 52(1):84–89
doi: 10.1097/MPG.0b013e3181f1572d
Kaye AJ, Rand EB, Munoz PS, Spinner NB, Flake AW, Kamath BM (2010) Effect of Kasai procedure on hepatic outcome in Alagille syndrome. J Pediatr Gastroenterol Nutr 51(3):319–321
doi: 10.1097/MPG.0b013e3181df5fd8
Ohi R, Ibrahim M (1992) Biliary atresia. Semin Pediatr Surg 1(2):115–124
pubmed: 1345477
Gunadi KM, Okamoto T, Sonoda M, Ogawa E, Okajima H et al (2019) Outcomes of liver transplantation for Alagille syndrome after Kasai portoenterostomy: Alagille syndrome with agenesis of extrahepatic bile ducts at porta hepatis. J Pediatr Surg 54(11):2387–2391
doi: 10.1016/j.jpedsurg.2019.04.022
Uto K, Inomata Y, Sakamoto S, Hibi T, Sasaki H, Nio M (2019) A multicenter study of primary liver transplantation for biliary atresia in Japan. Pediatr Surg Int 35(11):1223–1229
doi: 10.1007/s00383-019-04553-7
Japanese biliary atresia society (2019) Japanese biliary atresia registry in 2017. J Jpn Soc Pediatr Surg 55(2):291–297
Okazaki T, Ochi T, Nakamura H, Tsukui T, Koga H, Urao M et al (2019) Needle liver biopsy has potential for delaying Kasai portoenterostomy and is obsolete for diagnosing biliary atresia in the laparoscopic era. J Pediatr Surg 54(12):2570–2573
doi: 10.1016/j.jpedsurg.2019.08.028
Emerick KM, Rand EB, Goldmuntz E, Krantz ID, Spinner NB, Piccoli DA (1999) Features of Alagille syndrome in 92 patients: frequency and relation to prognosis. Hepatology 29(3):822–829
doi: 10.1002/hep.510290331
Lemoine C, Melin-Aldana H, Brandt K, Mohammad S, Superina R (2020) The evolution of early liver biopsy findings in babies with Jaundice may delay the diagnosis and treatment of biliary atresia. J Pediatr Surg 55(5):866–872
doi: 10.1016/j.jpedsurg.2020.01.027
Adams JM, Jafar-Nejad H (2019) The roles of Notch signaling in liver development and disease. Biomolecules 9(10):608–627
doi: 10.3390/biom9100608
Nio M, Wada M, Sasaki H, Tanaka H, Watanabe T (2015) Long-term outcomes of biliary atresia with splenic malformation. J Pediatr Surg 50(12):2124–2127
doi: 10.1016/j.jpedsurg.2015.08.040
Ober EA, Lemaigre FP (2018) Development of the liver: insights into organ and tissue morphogenesis. J Hepatol 68(5):1049–1062
doi: 10.1016/j.jhep.2018.01.005

Auteurs

Masahiro Takeda (M)

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. takeda-ma@ncchd.go.jp.

Seisuke Sakamoto (S)

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Hajime Uchida (H)

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Seiichi Shimizu (S)

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Yusuke Yanagi (Y)

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Akinari Fukuda (A)

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Takako Yoshioka (T)

Department of Pathology, National Center for Child Health and Development, Tokyo, Japan.

Mureo Kasahara (M)

Organ Transplantation Center, The National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH