We surveyed histochemically detectable
copper in various
liver diseases with emphasis on chronic biliary disease (CBD) and venous outflow impairment. Using
rhodanine, we graded
copper accumulation in 298 liver specimens: venous outflow impairment (n = 64), CBD (n = 123),
Wilson disease (WD) (n = 12),
chronic hepatitis C (n = 32),
steatohepatitis (n = 28),
sarcoidosis (n = 15), cholestatic
hepatitis (n = 12), and acute large
bile duct obstruction (n = 12).
Copper was detected in 39% of specimens; all had chronic
liver disease.
Copper increased with increasing
fibrosis. CBD accumulated
copper more frequently than other
chronic diseases (except WD), both in early (61% vs 3%) and late (94% vs 59%) stages and in larger amounts.
Rhodanine was positive in 73% of livers with CBD, 20% with
sarcoidosis, 9% with
chronic hepatitis C, and 7% with
steatohepatitis.
Copper was detected in 14% of chronic venous outflow impairment specimens; with 1 exception, stainable
copper was absent in early stages but detected in 38% of cirrhotic livers. In conclusion,
rhodanine helps differentiate CBD from other conditions, including venous outflow impairment; in the absence of advanced
fibrosis,
rhodanine positivity strongly favors CBD. In contrast,
rhodanine positivity is nonspecific in
cirrhosis, but the absence of
copper in that setting excludes CBD.