Epatiti autoimmuni in età pediatrica
Fiorentino, Francesco (2006) Epatiti autoimmuni in età pediatrica. [Tesi di dottorato] (Inedito)
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The autoimmune liver pathology in childhood even if it have, less epidemiologic importance if comparate with adulthood disease it represents an interesting chapter of hepatic pathology for the pathogenetic problem and therapeutic options. AIH can be defined as an inflammatory liver disease characterized histologically by a dense mononuclear cell infiltrate in the portal tract and serologically by the presence of non-organ and liver-specific autoantibodies, high transaminases and increased levels of IgG, in the absence of a known etiology. It usually responds to immunosuppressive treatment, which should be instituted as soon as diagnosis is made. Three types of autoimmune hepatitis have been proposed based on immunoserological markers: type I ANAor ASMA positive, type II LKM1 positive, type III SLA/LP (soluble liver antigen / liver-pancreas). Our aim is: morphologic and immunohistichemystry study for caratterizzation of Lymphocytic, often lymphoplasmacytic, infiltrates in the liver; histological difference between viral hepatitis and AIH in childhood. We selected a total of 14 children with evident clinical and/or biochemical evidence of liver disease associated with circulating autoantibodies, with averange age between 3and 14 years,all was derived from pediadric department of University Federico II of Napoli. Ryspectivelly 10 AIH typeI; and 4 AIH type II (LKM1). For control we have choosed 10 (of patients in childood age) hcv positinve biopsies, for compare, evaluation , and distiction between lymphocyte appraisal among AIH and chronic hepatitis of known cause. This evaluation was made with follow immunohistichemystry markers, TIA-1 (T cytotoxic marker), CD20(B marker), UCHL-1(T marker), GRANZYME-B(T cytotoxic marker), CD138 (plasmacell marker), CD3 (T marker), HLA-DR, beside also grading and staging was assessed. Results and conclusion: 10 cases have moderate score; 3 with low and 1 with high score. Immunohistichemystry analyse have showed no particular difference (exept for TIA-1 marker) between AIH and HCV control. Was confirm lobular and portal cell infiltrate is constitute (in majority part) by T (CD3 e UCHL1), both in AIH whether HCV.
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