Special stains can distinguish hepatic necrosis with regenerative nodules from cirrhosis

Background: Focal zones of hepatic necrosis alternating with nodular regeneration in severe, acute to subacute hepatitis can be difficult to differentiate histologically from established cirrhosis, and diagnostic errors can result in incorrect patient management. Thus, an easily applicable, well-defined histologic method for differentiating these two lesions would be useful. Methods: We examined trichrome (TRI), reticulin (RETIC), Verhoeff's elastic (VE), and orcein (ORC) stains on 13 cases of hepatic necrosis with regenerative nodules and 10 cases of end-stage cirrhosis to evaluate their utility for this problem. Results: Zones of recent necrosis in all severe hepatitis cases stained paler blue or pink, respectively, with TRI and VE than the established scar in cirrhosis or residual normal portal zones/central vein walls. With VE and ORC, elastic fibres were not seen in the necrotic zones of severe hepatitis, but were present in all cirrhotic livers. RETIC outlined the residual cell plate architecture in necrotic areas but had indistinct staining in fibrotic areas. The combination of the RETIC, TRI and ORC distinguished hepatic necrosis with regenerative nodules from nodules in the scar of established cirrhosis in 100% of the cases examined. Conclusions: We conclude that this trio of special stains can be helpful adjuncts for this diagnostic problem.