Histomorphometry of hepatic portal fibrosis in patient with surgical schistosomiasis mansoni

RESUMO

The usual histology report of hepatic fibrosis in patients with hepatosplenic schistosomiasis mansoni presents no association with hemodynamic and clinical liver parameters. Histomorphometry is adding a new tool of investigation for measuring density of portal fibrosis in these patients. This investigation was set up for assessing a possible agreement between the well-accepted international classification and the fibrosis density grades measured by histomorphometry. Thirty-five children and equal number of adults were included in this study. All patients underwent splenectomy and ligature of the left gastric vein. Histology findings were assessed in surgical liver biopsy stained with Masson trichrome. The official histology report was used as reference. The histomorphometric studies were done by semi-automatic morphometry. The mean percentage (X) of portal fibrosis plus or minus one standard deviation (SD) was classified as grade II (7.06 percent up to 34.72 percent); grade I was up to 7.06 percent; and grade III above 34.72 percent. Although, not reaching statistical significance, there is a tendency of the fibrosis to be more intense in children than adults (XñSD - 22.02ñ13.46 percent versus 20.63 percent ñ15.33 percent "t" = 0.379 p>0.05). Seven out of nine (77.8 percent) patients classified as grade I, by morphometry, had the same result on the official report, however, two (22.2 percent) were described as grade III. Sixteen out of forty-four (36.4 percent) classified as grade II on morphometry had the same classification as the histology grade, but, twenty seven (61.4 percent) were classified as grade III and one (2.3 percent) as grade I. Fifteen (21.4 percent) out of 70 patients had grade III on both classifications, but, two (11.8percent) out of seventeen G III on morphometry were grade II. The kappa (k) measurement of agreement between both classification was k = 0.319, showing a fair strength of association. The histomorphometric measurements of Symmers fibrosis in surgical patients with mansonic schistosomiasis partially support the report from The Department of Pathology - University Hospital, Federal University of Pernambuco - Brazil. However, there is a discrepancy in grade III. While in the official classification, the majority (62.8 percent) accounts for this grade, on morphometry only 38.6 percent represent the same grade. On the contrary, on morphometry, similar majority (62.8 percent) is grade II.