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HelpTest ID CUT Copper, Liver Tissue
Useful For
Diagnosing Wilson disease and primary biliary cirrhosis
Method Name
Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)
Reporting Name
Copper, Liver TsSpecimen Type
Liver TissueContainer/Tube:
Preferred: Mayo metal-free specimen vial (blue label) (Supply T173)
Acceptable: Paraffin block if no more than 1 or 2 cuts have been made to it for slides
Specimen Volume: 2 mg
Collection Instructions:
1. 2 mg of liver tissue is required. This is typically a piece of tissue from a 22-gauge needle biopsy at least 2 cm long. If an 18-gauge needle is used, the tissue must be at least 1 cm in length.
2. Any specimen vial other than a Mayo metal-free vial used should be plastic, leached with 10% nitric acid for 2 days, rinsed with redistilled water, and dried in clean air.
Additional Information:
1. If tissue is other than liver tissue, see MSCM / Miscellaneous Metals Testing.
2. Paraffin blocks will be returned 3 days after analysis.
Specimen Minimum Volume
2 cm (22-gauge needle), 1 cm (18-gauge needle), or 2 mm x 2 mm
(punch)
0.3 mg by dry weight
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Liver Tissue | Refrigerated (preferred) | |
| Ambient | ||
| Frozen | ||
Clinical Information
Homeostatic regulation of copper metabolism is very complex. The liver is the key organ to facilitate copper storage and incorporation of copper into the transport protein ceruloplasmin. Intestinal absorption and biliary excretion also play major roles in the regulation of copper homeostasis.
Abnormal copper metabolism is associated with liver disease. Elevated serum copper concentrations are seen in portal cirrhosis, biliary tract disease, and hepatitis, probably because excess copper that would normally be excreted in the bile is retained in circulation. In primary biliary cirrhosis, ceruloplasmin is high, resulting in high serum copper. Lesser elevations of hepatic copper are found in chronic copper poisoning, obstructive jaundice, and certain cases of hepatic cirrhosis. Reduced serum copper concentration is typical of Wilson disease (hepatolenticular degeneration). Wilson disease is characterized by liver disease, neurologic abnormalities, and psychiatric disturbances. Kayser-Fleischer rings are normally present and urinary copper excretion is increased, while serum copper and ceruloplasmin are low.
Reference Values
10-35 mcg/g dry weight
>1,000 mcg/g dry weight: VERY HIGH
This finding is strongly suggestive of Wilson disease. If this finding is without supporting histology and other biochemical test results, contamination during collection, handling, or processing should be considered. Fresh tissue would be appropriate for copper measurement. Genetic test for Wilson disease (WDMS / Wilson Disease Mutation Screen, ATP7B DNA Sequencing) is also available at Mayo Clinic. Please call Mayo Medical Laboratories at 800-533-1710 or 507-266-5700 if you need further assistance.
250-1,000 mcg/g dry weight: HIGH
This finding is suggestive of possible Wilson disease. If this finding is without supporting histology and other biochemical test results, contamination during collection, handling, or processing should be considered. Fresh tissue would be appropriate for copper measurement. Genetic test for Wilson disease (WDMS / Wilson Disease Mutation Screen, ATP7B DNA Sequencing) is also available at Mayo Clinic. Please call Mayo Medical Laboratories at 800-533-1710 or 507-266-5700 if you need further assistance.
35-250 mcg/g dry weight: HIGH
Excessive copper at this level can be associated with cholestatic liver disease, such as primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, and familial cholestatic syndrome. Heterozygous carriers for Wilson disease occasionally have modestly elevated values, but rarely higher than 125 mcg/g of dry weight. In general, the liver copper content is higher than 250 mcg/g dried tissue in patients with Wilson disease. If this finding is without supporting histology and other biochemical test results, contamination during collection, handling, or processing should be considered. Fresh tissue would be appropriate for copper measurement. Genetic test for Wilson disease (WDMS / Wilson Disease Mutation Screen, ATP7B DNA Sequencing) is also available at Mayo Clinic. Please call Mayo Medical Laboratories at 800-533-1710 or 507-266-5700 if you need further assistance.
Cautions
Specimen handling should be minimized.
Elevated copper levels without supporting histology or other biochemical test results should instigate an investigation into whether the specimen has been contaminated.
A minimum tissue dry weight of 0.3 mg is required for analysis. This is the equivalent of a piece of tissue from a 22-gauge needle approximately 0.5 cm long, or approximately 0.3 cm in length when taken with an 18-gauge needle. Since the specimen must be manipulated during analysis, more than the minimal amount described in the previous sentence must be submitted for analysis.
Paraffin blocks that have been cut for slides may be contaminated if the microtome was previously used to cut specimens that had been fixed with a copper-containing solution. Many fixatives, such as Hollandes, contain high levels of copper. Any object that has been exposed to these fixatives (eg, cutting boards, towels, containers, utensils) that comes into contact with the tissue can potentially contaminate the specimen. Rinsing and washing will not remove the copper contaminant. Therefore, submission of fresh-frozen, unfixed tissue is strongly recommended.
Gadolinium is known to interfere with most metals tests. If gadolinium-containing contrast media has been administered a specimen should not be collected for 96 hours.
See Improving Test Success in Iron Liver Tissue Specimens in Publications.
Day(s) Performed
Monday, Wednesday, Friday; 11 a.m.
Report Available
2 daysPerforming Laboratory
Mayo Medical Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
82525