A 34-year-old man evaluated for dyspnea has reduced serum alpha-1 antitrypsin levels. Liver biopsy performed to assess mild transaminase elevation shows round to oval eosinophilic cytoplasmic globules in periportal hepatocytes. These globules would be highlighted by which stain?

• A Masson trichrome stain
• B Prussian blue (Perls) stain
• C Rhodanine stain
• D Periodic acid-Schiff stain resistant to diastase digestion ✓

Explanation

In homozygous PiZZ alpha-1 antitrypsin deficiency, misfolded mutant Z protein polymerizes and accumulates as PAS-positive, diastase-resistant globules in the endoplasmic reticulum of periportal hepatocytes. Prussian blue stains ferric iron in hemochromatosis, rhodanine stains copper in Wilson disease, and Masson trichrome demonstrates collagen in fibrosis, so each highlights a different storage material. The globules may be sparse in children and increase with age, and their presence confirms hepatic involvement.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.