[Histochemical and ultrastructure study of bile cast in liver transplantation patients].
OBJECTIVE
To investigate the histological components and solubility of the bile-cast, and to study the pathological course of bile cast formation.


METHODS
HE staining, bilirubin staining (Gmelin reaction), Masson's staining, alcian blue staining and fibrin staining (weigert's) were performed on the formalin-fixed paraffin-embedded section of the bile cast. Ultrastructure was examined under the scanning electron microscope. Solubility test was also conducted using chymotrypsin, heparin, trypsin solution, HCl and NaOH solution to dissolve the bile-cast.


RESULTS
The major components of the bile-cast were bilirubin crystals and collagen fibers. Between the mass of collagen fibers there was certain blood vessel structure. Necrosis bile duct structure was not found in the cast. Under the scanning electron microscope, four kinds of crystal morphologies were viewed. There were some mucoid mass and necrosis defluvium epithelial cells in the bile cast. Solubility test showed that the bile cast could be partial dissolved in NaOH solution (pH = 12.5). No dissolution was found in HCl solution (pH = 5.0), chymotrypsin solution, heparin and trypsin solution.


CONCLUSIONS
Collagen fibers work as framework in the bile cast with bilirubin crystal filling between the framework. The emergence of fibroblast and blood vessels indicated the formation of bile cast might be the course of exudation and organization due to bile duct epithelium damage. Bile cast could be partially dissolved in alkaline solution, but could not be dissolved in acid solution, or in chymotrypsin, heparin and trypsin solutions.
Zhao
Qing-chuan
QC
Department of Hepatobiliary Surgery, Xijing Hospital, Fourth military Medical University, Xi'an 710032, China. zhaoqc@fmmu.edu.cn
Dou
Ke-feng
KF
He
Yong
Y
Dong
Hong-lin
HL
An
Jia-ze
JZ
Kong
Ya-lin
YL
Zhang
Peng
P
D001649:Bile Duct Diseases / Q000209:etiology / Q000473:pathology*; D001652:Bile Ducts / Q000648:ultrastructure*; D006801:Humans; D007150:Immunohistochemistry; D016031:Liver Transplantation / Q000009:adverse effects*; D008853:Microscopy; D011183:Postoperative Complications; D013194:Staining and Labeling