Lefkowitch J H, Yee H T, Sweeting J, Green P H, Magun A M
Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Hum Pathol. 1998 Feb;29(2):116-8. doi: 10.1016/s0046-8177(98)90219-2.
Stainable iron in the liver (hemosiderosis) is most commonly seen in individuals with homozygous genetic hemochromatosis, prior transfusion, hemolysis, porphyria cutanea tarda, and chronic alcohol-induced liver disease. In chronic viral hepatitis, however, significant hepatocellular hemosiderosis is uncommon. This report describes unusual foci of hepatocellular hemosiderosis ("iron-rich foci" or IRF) in liver biopsy specimens from three patients with chronic hepatitis with or without cirrhosis (two hepatitis C-related, one hepatitis B-related). IRF present within the lobular parenchyma or cirrhotic nodules contrasted sharply with the immediately adjacent hemosiderin-negative liver tissue. Serum iron indices were abnormal in all three patients, but homozygous hemochromatosis was ruled out based on the hepatic iron concentration and hepatic iron index for each case. These cases highlight the potential for irregular iron storage in chronic viral liver disease and possible confusion with genetic hemochromatosis. The possible pathogenesis of IRF and the relationship of iron storage to the outcome of interferon therapy in chronic viral hepatitis are discussed.
肝脏中的可染色铁（血色素沉着症）最常见于纯合子遗传性血色素沉着症、既往输血、溶血、迟发性皮肤卟啉症以及慢性酒精性肝病患者。然而，在慢性病毒性肝炎中，显著的肝细胞血色素沉着症并不常见。本报告描述了三名有或无肝硬化的慢性肝炎患者（两名丙型肝炎相关，一名乙型肝炎相关）肝脏活检标本中肝细胞血色素沉着症的异常病灶（“富铁病灶”或IRF）。小叶实质或肝硬化结节内的IRF与紧邻的含铁血黄素阴性肝组织形成鲜明对比。所有三名患者的血清铁指标均异常，但根据每例患者的肝铁浓度和肝铁指数排除了纯合子血色素沉着症。这些病例突出了慢性病毒性肝病中不规则铁储存的可能性以及与遗传性血色素沉着症可能存在的混淆。本文讨论了IRF可能的发病机制以及慢性病毒性肝炎中铁储存与干扰素治疗结果的关系。
