Stellate Cell Hyperplasia

 Varices, ascites if portal hypertension present


image Jaundice variably present


• Cutaneous, gastrointestinal, neuroophthalmic, musculoskeletal, renal, hematological manifestations also common

• Nonspecific elevations in transaminases, alkaline phosphatase

• Plasma vitamin A levels may be normal




Microscopic




• Stellate cell hyperplasia and hypertrophy

• Hepatocellular injury, inflammation minor

• Fibrosis begins in perisinusoidal pattern, may progress to cirrhosis


Top Differential Diagnoses




• Methotrexate therapy

• Steroid use

• IV fat emulsion administration

• Stellate cell activation has been reported in chronic viral hepatitis following transplantation

• May be marker of early fibrogenesis following transplantation

image
Hypervitaminosis
Low-power view of stellate cell hyperplasia in hypervitaminosis A illustrates bubbly, “multivacuolated” hepatic stellate cells in the sinusoids image. Note the lack of inflammation or hepatocyte degeneration.


image
Chronic Overingestion of Vitamin A
Hyperplastic, hypertrophic stellate cells are seen in the sinusoids of a patient who chronically overingested vitamin A supplements.

image
Hyperplastic and Hypertrophic Stellate Cells in Sinusoids
High magnification shows hyperplastic, hypertrophic stellate cells in the sinusoids with swollen, clear cytoplasm and delicate cytoplasmic processes.

image
Bubbly Cytoplasm of Stellate Cells
This patient does not have increased perisinusoidal fibrosis, but the contrast of the trichrome stain accentuates the bubbly cytoplasm of the stellate cells.


TERMINOLOGY


Abbreviations




• Hepatic stellate cells (HSC)


Synonyms




• Ito cell

• Perisinusoidal lipocyte


Definitions




• Phenotypic changes in stellate cells as result of activation
image Most commonly seen in vitamin A toxicity (hypervitaminosis A)

– Even moderate amounts of vitamin A can cause liver disease if taken over long period of time

• Stellate cells reside in space of Disse
image Long cytoplasmic processes surround sinusoids

image Contain small lipid droplets that are rich in vitamin A

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Related posts:

  1. Neonatal Hemochromatosis
  2. Hepatoportal Sclerosis
  3. Drug-Related Acute Hepatitis
  4. Biliary Atresia

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Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Stellate Cell Hyperplasia

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