Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia

Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant

K. E. Bove, R. Sheridan, L. Fei, R. Anders, C. T. Chung, Oscar Cummings, M. J. Finegold, L. Finn, S. Ranganathan, G. Kim, M. Lovell, M. S. Magid, H. Melin-Aldana, P. Russo, B. Shehata, L. Wang, F. White, Z. Chen, C. Spino, J. C. Magee

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We hypothesized that if infection is the proximate cause of congenital biliary atresia, an appropriate response to antigen would occur in lymph nodes contiguous with the biliary remnant. We compared the number of follicular germinal centers (GC) in 79 surgically excised hilar lymph nodes (LN) and 27 incidentally discovered cystic duct LNs in 84 subjects at the time of hepatic portoenterostomy (HPE) for biliary atresia (BA) to autopsy controls from the pancreaticobiliary region of non-septic infants >3 months old at death. All 27 control LN lacked GC, a sign in infants of a primary response to antigenic stimulation. GC were found in 53% of 106 LN in 56 of 84 subjects. Visible surgically excised LN contiguous with the most proximal biliary remnants had 1 or more well-formed reactive GC in only 26/51 subjects. Presence of GC and number of GC/LN was unrelated to age at onset of jaundice or to active fibroplasia in the biliary remnant but was related to older age at HPE. Absent GC in visible and incidentally removed cystic duct LNs predicted survival with the native liver at 2 and 3 years after HPE, P =.03, but significance was lost at longer intervals. The uncommon inflammatory lesions occasionally found in remnants could be secondary either to bile-induced injury or secondary infection established as obstruction evolves. The absence of consistent evidence of antigenic stimulation in LN contiguous with the biliary remnant supports existence of at least 1 major alternative to infection in the etiology of biliary atresia.

Original languageEnglish (US)
Pages (from-to)29-40
Number of pages12
JournalPediatric and Developmental Pathology
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2018

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Biliary Atresia
Germinal Center
Histology
Lymph Nodes
Hepatic Portoenterostomy
Liver
Cystic Duct
Jaundice
Infection
Coinfection
Age of Onset
Bile
Autopsy
Antigens
Wounds and Injuries

Keywords

  • biliary atesia
  • biliary remnant
  • germinal center reaction
  • Hilar lymph node
  • Kasai procedure
  • outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pathology and Forensic Medicine

Cite this

Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia : Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant. / Bove, K. E.; Sheridan, R.; Fei, L.; Anders, R.; Chung, C. T.; Cummings, Oscar; Finegold, M. J.; Finn, L.; Ranganathan, S.; Kim, G.; Lovell, M.; Magid, M. S.; Melin-Aldana, H.; Russo, P.; Shehata, B.; Wang, L.; White, F.; Chen, Z.; Spino, C.; Magee, J. C.

In: Pediatric and Developmental Pathology, Vol. 21, No. 1, 01.01.2018, p. 29-40.

Research output: Contribution to journalArticle

Bove, KE, Sheridan, R, Fei, L, Anders, R, Chung, CT, Cummings, O, Finegold, MJ, Finn, L, Ranganathan, S, Kim, G, Lovell, M, Magid, MS, Melin-Aldana, H, Russo, P, Shehata, B, Wang, L, White, F, Chen, Z, Spino, C & Magee, JC 2018, 'Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia: Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant', Pediatric and Developmental Pathology, vol. 21, no. 1, pp. 29-40. https://doi.org/10.1177/1093526617707851
Bove, K. E. ; Sheridan, R. ; Fei, L. ; Anders, R. ; Chung, C. T. ; Cummings, Oscar ; Finegold, M. J. ; Finn, L. ; Ranganathan, S. ; Kim, G. ; Lovell, M. ; Magid, M. S. ; Melin-Aldana, H. ; Russo, P. ; Shehata, B. ; Wang, L. ; White, F. ; Chen, Z. ; Spino, C. ; Magee, J. C. / Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia : Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant. In: Pediatric and Developmental Pathology. 2018 ; Vol. 21, No. 1. pp. 29-40.
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abstract = "We hypothesized that if infection is the proximate cause of congenital biliary atresia, an appropriate response to antigen would occur in lymph nodes contiguous with the biliary remnant. We compared the number of follicular germinal centers (GC) in 79 surgically excised hilar lymph nodes (LN) and 27 incidentally discovered cystic duct LNs in 84 subjects at the time of hepatic portoenterostomy (HPE) for biliary atresia (BA) to autopsy controls from the pancreaticobiliary region of non-septic infants >3 months old at death. All 27 control LN lacked GC, a sign in infants of a primary response to antigenic stimulation. GC were found in 53{\%} of 106 LN in 56 of 84 subjects. Visible surgically excised LN contiguous with the most proximal biliary remnants had 1 or more well-formed reactive GC in only 26/51 subjects. Presence of GC and number of GC/LN was unrelated to age at onset of jaundice or to active fibroplasia in the biliary remnant but was related to older age at HPE. Absent GC in visible and incidentally removed cystic duct LNs predicted survival with the native liver at 2 and 3 years after HPE, P =.03, but significance was lost at longer intervals. The uncommon inflammatory lesions occasionally found in remnants could be secondary either to bile-induced injury or secondary infection established as obstruction evolves. The absence of consistent evidence of antigenic stimulation in LN contiguous with the biliary remnant supports existence of at least 1 major alternative to infection in the etiology of biliary atresia.",
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AU - Bove, K. E.

AU - Sheridan, R.

AU - Fei, L.

AU - Anders, R.

AU - Chung, C. T.

AU - Cummings, Oscar

AU - Finegold, M. J.

AU - Finn, L.

AU - Ranganathan, S.

AU - Kim, G.

AU - Lovell, M.

AU - Magid, M. S.

AU - Melin-Aldana, H.

AU - Russo, P.

AU - Shehata, B.

AU - Wang, L.

AU - White, F.

AU - Chen, Z.

AU - Spino, C.

AU - Magee, J. C.

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