A 42-year-old patient with Wilson disease has Kayser-Fleischer rings and serum ceruloplasmin of 12 mg/dL. On liver biopsy, which histochemical stain would confirm hepatic copper accumulation?

• A Prussian blue (Perls') stain
• B PAS-diastase stain
• C Masson trichrome stain
• D Rhodanine or orcein stain ✓

Explanation

Hepatic copper accumulation in Wilson disease is demonstrated histochemically by rhodanine stain (red-orange granules) or orcein stain (which identifies copper-associated protein as brown-black granules); rubeanic acid is another alternative. Prussian blue stains iron (Fe3+) and would be used for haemochromatosis. PAS-diastase stains diastase-resistant PAS-positive globules seen in alpha-1-antitrypsin deficiency. Masson trichrome stains collagen/fibrosis. Atomic absorption spectroscopy on dry liver biopsy tissue is the quantitative gold standard, but rhodanine/orcein are the histochemical identifiers.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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