Histopathologic Evaluation of Liver Biopsy for Cirrhosis
Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA. Advances in anatomic pathology
(Impact Factor: 3.23).
07/2012; 19(4):220-30. DOI: 10.1097/PAP.0b013e31825c6bab
In current medical practice, the clinical diagnosis of cirrhosis is rendered when a patient has suggestive imaging findings or features of portal hypertension (pHTN). Liver biopsy may be considered to assess potential underlying cause(s). Cirrhosis, however, is not the only etiology of pHTN; in fact, schistosomiasis remains a significant factor worldwide. pHTN results from obstruction of hepatic blood flow; it is classified clinically based on either the anatomic location of obstruction or hepatic venous pressure gradient measurements. The clinical categories carry clinicopathologic significances. Histopathologically, pHTN is manifest with either cirrhotic or noncirrhotic features. Noncirrhotic pHTN results from a heterogeneous group of disease processes, all of which result in vascular remodeling with variable parenchymal nodularity and fibrosis. This review summarizes liver biopsy findings of cirrhosis and possible etiologies and provides a stepwise approach for the histologic differential diagnosis of a liver biopsy done for "cirrhosis."
Available from: PubMed Central
- "Cirrhosis is the end result of liver injury characterized by distortion of the hepatic architecture by extensive fibrosis and formation of regenerative nodules . Cirrhosis is defined by its typical pathological features: 1) presence of regenerating nodules of hepatocytes and 2) presence of bridging fibrosis between these nodules . "
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ABSTRACT: Pseudocirrhosis refers to a condition that shows changes in hepatic contour that mimic cirrhosis radiographically in the absence of the typical histopathological findings of cirrhosis. This condition has been observed in patients with cancer metastatic to the liver, both in those who have undergone prior systemic chemotherapy and those who have not. Pseudocirrhosis may cause difficulty in interpretation of the response to chemotherapy and hepatic decompression and complication of portal hypertension have a negative effect on the prognosis. We report on a case of breast cancer with liver metastases that showed cirrhotic changes during disease progression. Progression of liver metastases was confirmed by F18 fluorodeoxyglucose positron emission tomography/computed tomography (PET-CT). We also performed ultrasound-guided liver biopsy and confirmed tumor infiltration with severe desmoplastic fibrosis. This case suggests the pathogenesis of pseudocirrhosis through histopathological findings and the role of PET-CT in evaluation of the response to chemotherapy in patients with pseudocirrhosis.
Cancer Research and Treatment 01/2014; 46(1):98-103. DOI:10.4143/crt.2014.46.1.98 · 3.32 Impact Factor
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ABSTRACT: OBJECTIVE: To evaluate the efficacy and safety of entecavir (ETV) in patients with advanced schistosomiasis and hepatitis B virus (HBV) co-infection. METHODS: Sixty-seven patients with advanced schistosomiasis and HBV co-infection were enrolled in this study. The patients were randomly divided into the ETV treatment group (n=35) and the control group (n=32). The patients in the control group adopted routine supportive therapy for 52 weeks, and those in the ETV treatment group received ETV at a dose of 0.5mg once daily on the basis of routine supportive therapy for 52 weeks. Hepatic fibrosis markers (hyaluronic acid, type III procollagen, type IV collagen, laminin, and fibronectin), Ishak fibrosis score, alanine transaminase (ALT), HBV DNA, and Child-Pugh score were compared between the two groups. The intention to treat (ITT) population was used for the analysis. The measurement data and count data were analyzed by t-test and Chi-square test, respectively. RESULTS: After 52 weeks of treatment, the hepatic fibrosis markers (hyaluronic acid, type III procollagen, type IV collagen, laminin, and fibronectin) were significantly improved in the ETV treatment group compared to the control group (all p<0.05). A ≥1-point improvement in the Ishak fibrosis score was found in 25.7% (9/35) of the ETV group, and the mean change from the baseline in the Ishak fibrosis score was a 0.3-point reduction. The control group showed disease progression in the Ishak fibrosis score. More patients in the ETV group than in the control group had undetectable serum HBV DNA levels (82.9% vs. 3.1%, p<0.05) and ALT normalization (68.6% vs. 18.3%, p<0.05). The ETV treatment group demonstrated an improvement in Child-Pugh score at week 52 (-3.7 vs. 0.3, p<0.05). In addition, no obvious adverse reactions were observed during ETV treatment. CONCLUSION: ETV is safe and effective in patients with advanced schistosomiasis and HBV co-infection.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 03/2013; 17(8). DOI:10.1016/j.ijid.2013.01.023 · 1.86 Impact Factor
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Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) may cause damage to the hepatic artery (HA) and impact the postoperative course of the liver transplantation (LT). We aim to describe the relationship between preoperative TACE and the occurrence of histological and radiological hepatic artery complications (HAC).Methods
All cirrhotic patients with HCC undergoing liver transplantation between January 2009 and October 2012 were included and divided in 2 groups: TACE (group 1) and NO TACE (group 2). HA histological complications were reviewed and compared.ResultsSixty-seven patients were reviewed, 32 in group 1 and 35 in group 2. Both groups were similar in gender, age, cirrhosis origin, and American society of anesthesiology (ASA) score. After a mean follow-up of 17 months, 10 radiological HAC occurred; 7 in group 1 and 3 in group 2 (p=0.02). There was 1 thrombosis in each group; 6 non thrombotic complications in group 1 and 2 in group 2. Histological screening showed 12 HA injuries in group 1 (3 HA wall edemas, 5 fibrosis, 1 edema + fibrosis, 1 haemorragic necrosis + thrombosis, 2 thrombosis) and 3 in group 2 (2 HA wall edemas, 1 fibrosis) (p= 0.01). All these injuries were found at the proper HA and at the right/left HA bifurcation level.Conclusions
Despite the limits of our study, we found a higher incidence of radiological and histological injury in patients underwent TACE.This article is protected by copyright. All rights reserved.
Clinical Transplantation 03/2014; 28(5). DOI:10.1111/ctr.12358 · 1.52 Impact Factor
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