Pathology: iron deposition

Hepatic iron overload is a common histologic finding.  An elevated ferritin or transferrin saturation should prompt investigation for hereditary hemochromatosis (HH).  However, both of these labs are not specific for the diagnosis of HH; ferritin is an acute phase reactant and the transferrin saturation can be elevated in other chronic liver diseases, including alcoholic liver disease.

When trying to interpret the Prussian blue iron stain, look at the quantity as well as the location.  The quantity will give an indication of the severity.  The location will give a clue to the etiology of the iron.  If it is located primarily within the hepatocytes, it is more likely to be the result of an intrinsic metabolic derangement like HH.  If, however, it is primarily outside of the hepatocytes, lining the sinusoids/within Kupffer cells, it is more likely the result of secondary overload (ie. multiple blood transfusions).

In this biopsy, the iron appears to be mild to moderate in degree, and primarily within the hepatocytes.  This is an appropriate case to order the HFE gene mutation analysis.

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