2014 Current Issues in Pathology Special Stains in Liver Biopsy Pathology

UTILITY: (1) Assess degree of fibrosis. H&E stain is not reliable for demonstration of fibrosis especially in early stages. Pericellular fibrosis around the central vein in steatohepatitis can be difficult to identify on the H&E stain. (2) Distinguish fibrosis from necrosis. In acute hepatitis, areas of confluent necrosis can be difficult to distinguish from fibrosis and can lead to an erroneous interpretation of advanced fibrosis. Areas of necrosis show pale staining compared to dense staining of fibrous septa. (3) Raising the suspicion for amyloidosis. Amyloid deposits show pale homogenous staining compared to dark staining of collagen. In the absence of clinical suspicion, subtle amyloid deposits can be overlooked on the H&E stain. Trichrome stain can highlight the pale staining amyloid and definite identification can then be performed with Congo red stain.