Pathology of Hepatic Iron Overload

The growing availability of genetic tests for most inherited iron-overload conditions and our current ability to assess hepatic iron stores, and at a lesser extent, liver fibrosis by noninvasive methods have reduced the need for liver biopsy in patients with hepatic iron excess. Histologic evaluation of the liver remains useful (1) in well-defined genetic iron overload disorders to evaluate associated hepatic damage, (2) in unclassified genetic or acquired iron excess to guide etiologic diagnosis and to establish prognosis, and (3) in research studies for a whole and reliable assessment of the liver. The identification of iron overload, the description of its cellular and lobular distribution, semiquantitative assessment of its amount, and inventory of associated lesions, especially fibrosis, are the pathologist's main objectives.