Pathology of hepatic iron overload

Table 1 Histological grading of iron storage[2]

Grade	Ease of observation and magnification required
0	Granules absent or barely discernible at × 400
1	Granules barely discernible at × 250 and easily confirmed at × 250
2	Discrete granules resolved at × 100
3	Discrete granules resolved at × 25
4	Masses visible at × 10, or naked eye

Table 2 Histological grades of iron storage from Deugnier Y and Turlin B[3-12]

Hepatocytic iron	0, 3, 6, 9 or 12	HIS
	According granules size	0-36
	In each Rappaport area
Sinusoidal iron	0, 1, 2, 3 or 4	SIS
	According granules size	0-12
	In each Rappaport area
Portal iron	0, 1, 2, 3 or 4	PIS
	According to % of iron overloaded macrophages,	0-12
	biliary cells, and vascular walls
Total iron score		0-60

HIS: hepatocytic iron score; SIS: sinusoidal iron score; PIS: portal iron score.

Table 3 Main causes of hepatic iron overload according to the histological type of siderosis and associated lesions

Parenchymal iron overload
	With normal liver
		Early genetic hemochromatosis
		Nontransfused dysmyelopoiesis
		Hereditary aceruloplasminemia
	With cirrhosis
		Iron overload secondary to cirrhosis
Mixed iron overload
	With normal liver
		Insulin resistance syndrome
		Ferroportin disease
		Transfused dysmyelopoiesis
		Oral or parenteral iron supplementation
	With steatosis or steatohepatitis
		Insulin resistance syndrome
		Chronic alcoholism
	With chronic hepatitis
		Hepatitis C or B
		Wilson's disease
	With intrahepatocytic inclusions
		Porphyria cutanea tarda
	With cirrhosis
		Late genetic hemochromatosis
Mesenchymal iron overload
	With normal liver
		Inflammatory syndrome
		Repeated transfusions