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Int J Anat Res 2017, 5(3.2):4284-89. ISSN 2321-4287 4284
Original Research Article
MORPHOLOGICAL STUDY OF ADULT HUMAN CADAVERIC LIVER
Mohini M.Joshi *1, Sushama K. Chavan 2.
ABSTRACT
Address for Correspondence: Dr. Mohini M. Joshi, Associate Professor, Department of Anatomy,
Rural Medical College, Pravara Institute of Medical Sciences Loni, Dist. Ahmadnagar Maharashtra,
India. Mobile No: +919823064062, E-Mail: atharvamohini@gmail.com
Background: The liver is the largest of the abdominal viscera, occupying a substantial portion of the upper
abdominal cavity. It is essential to have knowledge of the normal and variant liver anatomy.
Objective: Objective of the present study was to study morphology of liver and its variations.
Materials and Methods: The hundred liver specimens available in the department of Anatomy were studied. The
liver specimens were numbered and photographs were taken along with proper documentation. Caudate and
quadrate lobes of the liver were studied in detail for the size, shape, accessory fissures, and accessory lobes.
For each of the parameters, the mean, standard deviation (S.D.) and range (minimum value-maximum value) was
calculated.
Result: The mean length of the caudate lobe was 5.33±1.01, breadth 2.75 ±0.65 and depth 1.93±0.55 while length
of the quadrate lobe was 5.91±1.18 and breadth 3.00±0.80. The mean length of the right lobe was 13.62±2.23,
breadth 8.13±1.45 while length of the left lobe was 12.20±2.12 and breadth 7.65±1.51. Morphological variations
like caudate process, accessory fissures, Pons Hepatis, lingual process, papillary process, accessory lobes and
variations in shapes of caudate and quadrate lobes were observed and reported.
Conclusion: This study highlights some of the variations in the lobes and fissures of the liver. Various shapes of
the caudate lobe and quadrate lobe were encountered. Knowledge of anatomical and morphological variations
of liver is important for anatomist as well as for radiologist and hepatobiliary surgeons.
KEY WORDS: Liver, Morphology, Quadrate, Caudate, Variations.
INTRODUCTION
International Journal of Anatomy and Research,
Int J Anat Res 2017, Vol 5(3.2):4284-89. ISSN 2321-4287
DOI: https://dx.doi.org/10.16965/ijar.2017.310
Access this Article online
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ISSN 2321-4287
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DOI: 10.16965/ijar.2017.310
*1 Associate Professor, Department of Anatomy Rural Medical College, Pravara Institute of Medi-
cal Sciences, Loni, Maharashtra, India.
*2 Professor and Head, Department of Anatomy, Rural Medical College, Pravara Institute of Medi-
cal Sciences, Loni, Maharashtra, India.
Received: 20 June 2017
Peer Review: 21 June 2017
Revised: None
Accepted: 03 Aug 2017
Published (O): 31 Aug 2017
Published (P): 31 Aug 2017
quadrate lobes by the surface peritoneal and
ligamental attachments [1]. It is essential to
have knowledge of the normal and variant liver
anatomy as it is a prerequisite to having a
favorable surgical outcome and commonly
occurring variations assumes even more signifi-
cance in the era of diagnostic imaging and
minimally invasive surgical approaches. Hepatic
The liver is the largest of the abdominal viscera,
occupying a substantial portion of the upper
abdominal cavity. It occupies most of the right
hypochondrium, epigastrium, and frequently
extends into the left hypochondrium as far as
the left lateral line. The liver has been consid-
ered to be divided into right, left, caudate and
Int J Anat Res 2017, 5(3.2):4284-89. ISSN 2321-4287 4285
imaging is usually performed to search for
primary or metastatic liver diseases [2]. The
major fissures are important landmarks for
interpreting the lobar anatomy and locating the
liver lesions. Variations can have a clinical
presentation or indicate an underlying pathologi-
cal condition. Detailed studies of the macro-
scopic anatomy of cadaveric livers can still
contribute to the identification of important ana-
tomical variations. With this background in mind
the present study was carried out on cadaveric
liver to study morphology and its variations.
RESULTS
The study was approved by Institutional Ethical
Committee. The 100 liver specimens were
obtained from adult human embalmed cadav-
ers during routine dissection in the department
of anatomy at a tertiary care teaching hospital.
They were preserved in 10% of formalin. Cadav-
eric liver in good state were utilized for study
and those which are damaged were omitted
from study. The liver specimens were numbered
and photographs were taken along with proper
documentation. Caudate and quadrate lobes of
the liver were studied in detail for the size,
shape, accessory fissures, and accessory lobes.
Following measurements were recorded on cau-
date and quadrate lobe of the liver.
1. Length of caudate lobe
2. Breadth of caudate lobe
3. Depth of caudate lobe
4. Length of quadrate lobe
5. Breadth of quadrate lobe
6. Length of right lobe
7. Breadth of right lobe
8. Length of left lobe
9. Breadth of left lobe
Thread, scale and vernier caliper were used for
measurement. Variations, if any, were observed,
recorded and photographed.
Statistical analysis: For each of the parameters,
the mean, standard deviation (S.D.) and range
(minimum value-maximum value) was calcu-
lated.
The hundred liver specimens available in the
department of Anatomy were studied. The mean
length of the caudate lobe was 5.33±1.01,
MATERIALS AND METHODS
breadth 2.75 ±0.65 and depth 1.93±0.55 while
length of the quadrate lobe was 5.91±1.18 and
breadth 3.00± 0.80.
Table 1: Measurements of lobes of the liver.
S. No Measurements Mean. S.D Range
1 Length of Caudate Lobe 5.33 1.01 2.4-8
2 Breadth of Caudate Lobe 2.75 0.65 1-4.7
3 Depth of Caudate Lobe 1.93 0.55 0.7-3.3
4 Length of Quadrate Lobe 5.91 1.18 3.6-9.8
5 Breadth of Quadrate Lobe 3 0.8 1.4-5.2
6 Length of Right Lobe 13.62 2.23 8.5-18.9
7 Breadth of Right Lobe 8.13 1.45 May-16
8 Length of Left Lobe 12.2 2.12 5.5-17.4
9 Breadth of Left Lobe 7.65 1.51 3.4-12.3
The mean length of the right lobe was
13.62±2.23, breadth 8.13±1.45 while length of
the left lobe was 12.20±2.12 and breadth 7.65±
1.51. (Table1) Six liver specimens were having
right lobe smaller than left lobe and superficial
veins on the surface of liver were observed in
15% of specimens.
Table 2: Morphological features/ Variations.
S. No Morphological features No (%)
1 Caudate process 52(52)
2Accessory fissure on inferior margin of
caudate lobe
20(20)
3Quadrate lobe- accessory fissure along the
middle of fissure for ligamentum teres
34 (34)
4
Accessory Fissure on the liver surface
extending from the right margin of porta
hepatis into the inferior surface of the right
lobe
19 (19)
5 Fissure present along center of quadrate lobe 5(5)
6 Papillary process 5(5)
7 Accessory lobes 5(5)
8Accessory multiple fissures on right lobe on
inferior surface
3(3)
9Pons Hepatis- Left lobe connected to quadrate
lobe
13(13)
10 Lingual process 10(10)
11 Diaphragmatic or costal grooves 2(2)
12 Appendix of liver 1(1)
13 Absent caudate lobe 1(1)
14 Absent quadrate lobe 2(2)
The Morphological features/ variations of liver
can be seen in Table 2.These data suggest a high
incidence of anatomical variation in the human
liver. Caudate process was observed in 52%.
Accessory fissure on inferior margin of caudate
lobe was seen in 20% and accessory fissure
along the middle of fissure for ligamentum teres
Mohini M.Joshi, Sushama K. Chavan. MORPHOLOGICAL STUDY OF ADULT HUMAN CADAVERIC LIVER.
Int J Anat Res 2017, 5(3.2):4284-89. ISSN 2321-4287 4286
in 34% of quadrate lobe. Accessory Fissure on
the liver surface extending from the right mar-
gin of porta hepatis into the inferior surface of
the right lobe was observed in 19%. [Fig.1-6].
Pons hepatis (PH) was found in 13%. [Fig.4-6]
Accessory lobes were present in 5% of speci-
mens. [Fig.6-7] Lingual process was found in 10%
[Fig 2 & 8]. Papillary process was present in 5%
of specimens [Fig 9]. Other variations noted
were appendix of liver in one specimen, an
absence of quadrate lobe in 2 and caudate lobe
in one liver specimen and diaphragmatic or cos-
tal grooves in 2 specimens [Fig 10, 11 and 12].
Fig. 1: Fissures of the liver.
Fig. 2: Lingular process of left lobe of liver , notch and
fissure on inferior surface
Fig. 3: Caudate process and fissure extending from Porta
Hepatis.
Fig. 4: Pons Hepatis on upper one third of fissure for
ligamentum teres .
Fig. 5: Fissure extending from porta hepatis to inferior
surface of liver.
Fig. 6: Accessory lobe of caudate lobe and Pons Hepatis.
Fig. 7: Accessory lobe.
Mohini M.Joshi, Sushama K. Chavan. MORPHOLOGICAL STUDY OF ADULT HUMAN CADAVERIC LIVER.
Int J Anat Res 2017, 5(3.2):4284-89. ISSN 2321-4287 4287
Fig. 8: Lingular process of left lobe of liver.
Fig. 9: Papillary process.
Fig. 10: Appendix of liver and fissure separating acces-
sory lobe at the top of left lobe.
Fig. 11: Absence of quadrate lobe.
Fig . 12: Costal grooves on the right surface.
Table 3: Shapes of the Quadrate and Caudate Lobes of
the liver.
S. No Shape Quadrate lobe
Caudate lobe
(n=99)
1 Rectangular 68(68) 74(74)
2 Triangular 16(16) 9(9)
3 Pear shaped 4(4) 5(5)
4 Leaf shaped 1(1) -
5 Cuboidal 4(4) 3(3)
6 Squared 2(2) 3(3)
7 Elongated 3(3) 5(5)
The shapes of the caudate lobe and quadrate
lobe showed wide range of variations. The
caudate lobe was rectangular in 68%, triangu-
lar in 16%, pear shaped and cuboidal in 4%. The
quadrate lobe was rectangular in 74%, triangu-
lar in 9%, pear shaped and elongated in 5 %
(Table 3).
DISCUSSION
The mean length of the caudate lobe was
5.33±1.01, breadth 2.75 ±0.65 and depth
1.93±0.55 while length of the quadrate lobe was
5.91±1.18 and breadth 3.00± 0.80. Sahni et al
reported length 4-7.2 cm and width 1.8-4.1 of
caudate lobe.[3] In a study by Reddy et al the
average height of caudate lobe was 4.78 cm
(Range 2.4-7.8 cm) and the width was 2.54 cm
(Range 1.1- 3.2 cm). The average height of the
quadrate lobe was 5.48 cm (Range 2.38 - 9.1
cm) and the width was 2.84 cm (Range 1.57-
6.3 cm) [4].
In the present study, the caudate process was
present between the porta hepatis anteriorly and
the fossa for the inferior vena cava posteriorly
in 52% of specimens. Sahni et al found that the
caudate process was present in 119 (59.5%)
specimens [3]. Accessory fissure on inferior
Mohini M.Joshi, Sushama K. Chavan. MORPHOLOGICAL STUDY OF ADULT HUMAN CADAVERIC LIVER.
Int J Anat Res 2017, 5(3.2):4284-89. ISSN 2321-4287 4288
margin of caudate lobe was seen in 20% while
accessory fissure along the middle of fissure for
ligamentum teres in 34% of quadrate lobe. Joshi
et al reported an incidence of 30% [5]. Sunitha
et al reported an incidence 15.5% of accessory
fissure on quadrate lobe [6]. Auh et al reported
that the accessory hepatic fissures are poten-
tial sources of diagnostic errors during imaging
such as; collection of fluid in these fissures may
be mistaken for a liver cyst, intrahepatic
haematoma or liver abscess. [7] Accessory
fissures can be caused by gastric volvulus,
diaphragmatic hernia, portal hypertension,
obstructive pulmonary disease, hypertrophic
diaphragmatic bundles or rarely by the pressure
of adjacent organs and structures (due to the
fact that adjacent structures usually leave an
impression but not a fissure) [5, 8, 9].They can
be markers of hepatic “weak zone” an area
with low vascularization which can be useful
during resection[10, 11]. These fissures are also
important in today’s laparoscopic minimally
invasive techniques and segmental resection of
liver.
Pons hepatis was found in 13% of specimens.
Saritha et al [12] have reported the incidence of
pons hepatis in 4% of livers while Patil et al [13]
found it in 10% of specimens examined. Joshi et
al found a higher incidence (30%) of Pons
hepatis [5]. Prominent papillary process was
observed in 5(5%) of the livers. Joshi SD et al
have reported prominent papillary process in 33%
of the livers in their study [5]. In present study,
there was an absence of quadrate lobe in 2 and
caudate lobe in one liver specimen. Aktan et al
observed an absence of the caudate lobe with
7.41% of the 54 livers studied [14]. Ebby et al
reported a case of complete absence of quad-
rate lobe [15].
In present study, the caudate lobe was rectan-
gular in 68%, triangular in 16%, pear shaped and
cuboidal in 4%. The quadrate lobe was rectan-
gular in 74%, triangular in 9%, pear shaped and
elongated in 5 %. Sahni et al reported that 94.5
of specimens were rectangular, 9(4.5%) pyri-
form and 2 (1%) irregular[3]. Joshi et al observed
that out of 90 specimens studied, 58% were
rectangular, 20% bicornuate, and rest 22% cau-
date lobe had different shapes, i.e. pear-shaped,
quadrate, triangular, elongated, heart-shaped,
square and inverted pear-shaped. The shape of
quadrate lobe was rectangular in 66% and in 6%
of the cases, the quadrate lobe was very
narrow [5]. Sarla et al (2015) in their study found
rectangular shape in 58%, pear shape in 10%,
irregular in 20%, and triangular in 8% [16].
Lingular process was observed in 10% of the
livers. Ranjana Singh et al reported tongue like
projection of left lobe in 9 livers (15%) [17].
CONCLUSION
Conflicts of Interests: None
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hepatobiliary surgeons.
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Int J Anat Res 2017, 5(3.2):4284-89. ISSN 2321-4287 4289
Mohini M.Joshi, Sushama K. Chavan. MORPHOLOGICAL STUDY OF ADULT HUMAN CADAVERIC LIVER.
How to cite this article:
Mohini M.Joshi, Sushama K. Chavan. MORPHOLOGICAL STUDY
OF ADULT HUMAN CADAVERIC LIVER. Int J Anat Res
2017;5(3.2):4284-4289. DOI: 10.16965/ijar.2017.310
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human liver and its surgical importance. Int J Anat
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215.
... The fissure of the quadrate lobe in the majority of the data in the literature, vary between 2 and 5% [3,4,[8][9][10]. Which is low compared to our study where we noted 15% fissure. ...
... The absence of the quadrate lobe remains rare in the various studies of the literature. Indeed, Sharmila[3] noticed the absence of the quadrate lobe in 3 cases (5%) while Joshi MM[4] observed it in 2 cases (2%). However, by observing the illustrations of these cases of absence of the square lobe in these different studies, it seems more reasonable to185 Morphological Study of the Quadrate Lobe of the Liver Citation: Seye C., et al. "Morphological Study of the Quadrate Lobe of the Liver". ...
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