Comparison of the Stereological Study Findings of Liver Biopsy Between Biliary Atresia and Neonatal Hepatitis: Is It Helpful in Differentiating Them?

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Abstract
Background: The two most common causes of neonatal cholestasis are biliary atresia (BA) and neonatal hepatitis (NH). Differentiating between them needs meticulous investigations. Objectives: We aimed to evaluate the different stereological findings of liver biopsies in BA and NH to find features that might be helpful in differentiating them from each other. Patients and Methods: Five patients with BA and four patients with NH were recruited. The study was restricted to infants with confirmed diagnosis through lab data, histopathological findings in liver biopsies, and by intraoperative cholangiography. The liver biopsies were evaluated with stereological study for the followings: volume density of connective tissue, fibrosis, hepatocytes, bile duct, and sinusoid; the diameter of duct, epithelium, and lumen; the length density of duct; numerical density cell; and the mean volume of hepatocyte and nucleus. Results: The stereological study findings revealed that the mean volume density of the connective tissue and fibrosis in NH was about 17.5% less than BA group. However, the other parameters did not show any significant difference between them. Conclusions: Our results showed that portal fibrosis was a significant stereological study finding in BA that could differentiate it from NH. This study is the first stereological analysis of the patients with neonatal cholestasis. Further studies in this field are required to confirm our findings. Keywords: Biliary Atresia; Hyperbilirubinemia, Neonatal; Alloimmune Hepatitis, Congenital

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