J Pathol Transl Med.  2019 Jul;53(4):253-260. 10.4132/jptm.2019.05.03.

Progressive Familial Intrahepatic Cholestasis in Korea: A Clinicopathological Study of Five Patients

• Kang HJ
• Hong SA
• Oh SH
• Kim KM
• Yoo HW
• Kim GH
• Yu E

• KMID: 2454605
• DOI: http://doi.org/10.4132/jptm.2019.05.03

Abstract

BACKGROUND
Progressive familial intrahepatic cholestasis (PFIC) is a heterogeneous group of autosomal recessive liver diseases that present as neonatal cholestasis. Little is known of this disease in Korea.
METHODS
The records of five patients histologically diagnosed with PFIC, one with PFIC1 and four with PFIC2, by liver biopsy or transplant were reviewed, and ATP8B1 and ABCB11 mutation status was analyzed by direct DNA sequencing. Clinicopathological characteristics were correlated with genetic mutations.
RESULTS
The first symptom in all patients was jaundice. Histologically, lobular cholestasis with bile plugs was the main finding in all patients, whereas diffuse or periportal cholestasis was identified only in patients with PFIC2. Giant cells and ballooning of hepatocytes were observed in three and three patients with PFIC2, respectively, but not in the patient with PFIC1. Immunostaining showed total loss of bile salt export pump in two patients with PFIC2 and focal loss in two. Lobular and portal based fibrosis were more advanced in PFIC2 than in PFIC1. ATP8B1 and ABCB11 mutations were identified in one PFIC1 and two PFIC2 patients, respectively. One PFIC1 and three PFIC2 patients underwent liver transplantation (LT). At age 7 months, one PFIC2 patient was diagnosed with concurrent hepatocellular carcinoma and infantile hemangioma in an explanted liver. The patient with PFIC1 developed steatohepatitis after LT. One patient showed recurrence of PFIC2 after 10 years and underwent LT.
CONCLUSIONS
PFIC is not rare in patients with neonatal cholestasis of unknown origin. Proper clinicopathologic correlation and genetic testing can enable early detection and management.

Keyword

Progressive familial intrahepatic cholestasis; Bile salt export pump; ABCB11; ATP8B1

MeSH Terms

Bile
Biopsy
Carcinoma, Hepatocellular
Cholestasis
Cholestasis, Intrahepatic*
Fatty Liver
Fibrosis
Genetic Testing
Giant Cells
Hemangioma
Hepatocytes
Humans
Jaundice
Korea*
Liver
Liver Diseases
Liver Transplantation
Recurrence
Sequence Analysis, DNA

Figure

• 

  Fig. 1. Histologic findings in patients with progressive familial intrahepatic cholestasis (PFIC). (A) Bland canalicular cholestasis and small cell change of hepatocytes with lobular disarray in our PFIC-1 patient. Bile duct proliferation with cholangiolar cholestasis (B), ballooning change (C), and giant cell transformation of hepatocytes (D) in patients with PFIC-2.

• 

  Fig. 2. Stages of fibrosis in patients with progressive familial intrahepatic cholestasis (PFIC). (A) Cirrhosis with diffuse lobular fibrosis in a PFIC2 patient, as shown by Masson trichrome staining. (B) Periportal fibrosis with mild lobular fibrosis in the one patient with PFIC1.

• 

  Fig. 3. Electron microscopic findings in patients with progressive familial intrahepatic cholestasis (PFIC). (A) Dilated canaliculi (arrows) with coarse granular bile in the PFIC1 patient. (B) Amorphous and dense bile in PFIC2 patients.

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  Fig. 4. Immunohistochemical staining for bile salt export pump: normal canalicular expression (A), focal loss (B), and total loss (C).

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