Differential diagnosis of hereditary hemochromatosis from other liver disorders by genetic analysis: gene mutation analysis of patients previously diagnosed with hemochromatosis by liver biopsy.

BACKGROUND: Hereditary hemochromatosis, a common autosomal recessive trait caused by mutations in the HLA-H gene, is often diagnosed by the pathologist at the time of histologic examination. Unfortunately, histologic parameters alone do not differentiate between hereditary hemochromatosis and other causes of iron overload. We performed a retrospective study to determine the frequency of familial hemochromatosis in patients diagnosed with he mochromatosis by abnormal liver histology. METHODS AND RESULTS: DNA was isolated from paraffin-embedded tissue sections from 15 patients and used in a polymerase chain reaction-based assay in which we tested for the C282Y and H63D mutations. We found that in this group of patients, 5 (33%) were homozygous for the common C282Y genetic mutation, 3 (20%) were heterozygous, and 7 (47%) were normal. CONCLUSIONS: Our study shows that the molecular assay is the gold standard for the diagnosis of hereditary hemochromatosis. The case study also illustrates that a definitive diagnosis of familial hemochromatosis has significant counseling implications allowing for accurate family studies.

Normal anatomic variant: scintigraphy of the ischiopubic synchondrosis.

Radionuclide bone imaging in pediatric patients occasionally shows a focus of distinct localized increase of radiotracer uptake at the ischiopubic synchondrosis. Correlation of radionuclide bone images and conventional radiographs of this area in a group of pediatric patients demonstrates the positive bone scans to correlate with the period of beginning but incomplete fusion of the synchondrosis. This represents a normal phase of skeletal development that radiographically and scintigraphically may mimic disease and should not be confused with a focus of pathologic activity.