Clinical associations of hepatic stellate cell (HSC) hyperplasia

Hepatic stellate cell (HSC) hyperplasia has been principally attributed to hypervitaminosis A. There are sporadic reports of HSC hyperplasia in other conditions such as chronic biliary disease and hepatitis C, but clinical associations of this entity have not been studied in detail. We aimed to investigate the clinical associations of HSC hyperplasia aside from hypervitaminosis A. We identified 34 patients whose liver histology showed HSC hyperplasia. We reviewed the liver samples; additional histologic findings in addition to HSC hyperplasia were consolidated into a histologic diagnosis. We collected clinical, laboratory, and radiologic data; the histologic diagnosis was combined with this data to reach an "overall diagnosis." Four patients had hypervitaminosis A (all native livers). In native livers (n=24), HSC hyperplasia also occurred in association with drug-induced hepatitis [n=6, niacin was the most common inducing agent (n=3)], reactive hepatitis (n=4), chronic hepatitis C (n=4), autoimmune hepatitis (n=3), steatohepatitis (n=1), chronic biliary disease (n=1), and portal venopathy (n=1). In liver allografts (n=10), HSC hyperplasia was seen in protocol biopsies without other significant abnormalities (n=5), chronic biliary disease (n=4), and acute cellular rejection (n=1). All patients used medications (total of 99) and 82 % were on multiple medications. HSC hyperplasia is an uncommon and relatively nonspecific finding that most commonly occurs in multimedicated patients, often in the absence of hypervitaminosis A. Associated conditions include drug toxicity (such as niacin), post-liver transplant setting, reactive hepatitis (due to systemic illness or inflammatory disorders of the gastrointestinal tract), and chronic liver disease.