ABSTRACT
BACKGROUND:
Hepatoportal sclerosis HPS or obliterative portal venopathy (OPV), one of the differential diagnoses for non-cirrohtic portal hypertension, is characterized by the disappearance of the portal branches, portal and septal fibrosis, perisinusoidal fibrosis and regenerative nodular hyperplasia (RNH). It is a spectral disease that may progress to severe portal hypertension. Its etiopathogenesis is still little understood, especially in Brazil, it has been probably misdiagnosed due to its histopatological similarities with the hepatosplenic form of schistosomiasis.
OBJECTIVE:
To analyze the profile of patients with HPS in Northeastern Brazil and to demonstrate the pathological characteristics of HPS.
METHODS:
We retrospectively analyzed cases of OPV in liver biopsies and explants from a referral center for liver in Bahia - Brazil. The qualitative and quantitative analysis of the portal tracts and liver parenchyma was made so that comparisons could be done among the HPS findings of our population and the findings described by other authors.
RESULTS:
From the 62 patients identified with HPS, 42% were male, while 58% were female. The average age at diagnosis was 48.3 years. From this group, we analyzed the liver biopsy of 10 patients whose diagnosis of schistosomiasis could be ruled out. From these 100% (10/10) presented dense portal fibrosis and portal venous obliteration. Liver parenchymal atrophy was present in 60% (6/10) of the patients, sinusoidal dilation was present in 30% (3/10), the presence of portal septa occurred in 50% (5/10) and dense portal fibrosis in all patients analyzed. Nodular regenerative hyperplasia was found in 30% (3/10) of the patients.
CONCLUSION:
HPS seems to be neglected and misdiagnosed in Brazil, due to its similarities with schistossomiasis. In our study dense portal fibrosis, obliteration of the portal vein branches, parenchymal atrophy, sinusoidal dilatation and parenchymal nodular hyperplasia were the main histopathological findings and were similar to that described in other countries.
Keywords:
Hepatoportal sclerosis; obliterative portal venopathy; portal hypertension; schistosomiasis
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A. HE stained portal spaces showing portal tract retraction. B. Picrosirius-stained showing numerous sclerosed portal tracts with retraction of the portal spaces and important widening of others. C. Picrosirius-stained showing the approximation of hepatic vascular structures (portal space and centrilobular veins) secundary to parenchymal atrophy. D. Portal space with sclerosis and disapparance of the portal vein branch, consistente with POV, is observed, as well as, perissinusoidal fibrosis and sinusoidal dilation, especially in the upper left quadrant of the image. E. Slide showing POV, approximation of vascular structures and formation of parenchymal nodules in the absence of fibrosis, consistent with NRH.