Alpha(1)-antichymotrypsin globules within hepatocytes in patients with chronic hepatitis C and cirrhosis

Alpha(1)-antichymotrypsin (A(1)AC) is an acute phase serine protease inhibi tor, similar to alpha(1)-antitrypsin (A(1)AT) in amino acid sequence. A(1)A T deficiency is known to be associated with emphysema and cirrhosis; defici ency of serum A(1)AC has been reported to be associated with emphysema, chi ldhood asthma, and cryptogenic cirrhosis. The hepatocyte globules associate d with A(1)AT deficiency have been well described; A(1)AC deficiency also h as been reported to be associated with hepatocyte globules. The aim of this study was to describe the globules of A(1)AC and to compare them with A(1) AT globules. Immunohistochemistry for A(1)AC and A(1)AT was performed on li ver biopsy specimens from 15 hepatitis C virus (HCV)-positive cirrhotic pat ients, 14 non-HCV cirrhotic patients, and 12 other patients with chronic he patitis C but no cirrhosis, all of whom had known serum levels of A(1)AC; m ost had known serum levels of A(1)AT. Five of 15 HCN-positive cirrhotic pat ients, 1 of 14 non-HCV cirrhotic patients, and 1 of 12 noncirrhotic chronic hepatitis C patients had A(1)AC globules. Two of 15 HCV-positive cirrhotic patients and 2 of 14 non-HCV cirrhotic patients had A(1)AT globules. Histo logically, the globules of A(1)AC were similar to those of A(1)AT but were smaller and fewer; the PAS/D stain was not as helpful for A(1)AC as it was for A(1)AT; immunohistochemistry was most useful. There was not a good corr elation between serum levels of A(1)AC and its globules in hepatocytes. A(1 )AC globules should be included in the differential diagnosis of hepatocyte inclusions. Copyright (C) 2000 by W.B. Saunders Company.