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Difference between revisions of "Liver pathology"
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→Fibrosis
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***The normal reticulin pattern is chicken wire-like; in early pre-cirrhosis (Grade 1-2) the chicken wire is collapsed/flattened. | ***The normal reticulin pattern is chicken wire-like; in early pre-cirrhosis (Grade 1-2) the chicken wire is collapsed/flattened. | ||
''Toronto General Hospital'' uses ''Laennec fibrosis''; named after French chest physician.<ref name=pmid3304599>Why does cirrhosis belong to Laennec? Duffin JM. CMAJ. 1987 Sep 1;137(5):393-6. PMID 3304599. URL: [http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1492806&pageindex=4 http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1492806&pageindex=4]</ref> | The ''Toronto General Hospital'' uses the ''Laennec fibrosis'' system; named after the French chest physician.<ref name=pmid3304599>Why does cirrhosis belong to Laennec? Duffin JM. CMAJ. 1987 Sep 1;137(5):393-6. PMID 3304599. URL: [http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1492806&pageindex=4 http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=1492806&pageindex=4]</ref> This can be considered a modification of the Batts-Ludwig system,<ref name=pmid7503362>{{cite journal |author=Batts KP, Ludwig J |title=Chronic hepatitis. An update on terminology and reporting |journal=Am. J. Surg. Pathol. |volume=19 |issue=12 |pages=1409–17 |year=1995 |month=December |pmid=7503362 |doi= |url=}}</ref> which does ''not'' split ''Stage 4'' into ''4A'', ''4B'' and ''4C''. | ||
''Laennec fibrosis'' (stage):<ref>[http://www.pulsus.com/cddw2000/abs/080.htm http://www.pulsus.com/cddw2000/abs/080.htm]</ref> | ''Laennec fibrosis'' (stage):<ref>URL: [http://www.pulsus.com/cddw2000/abs/080.htm http://www.pulsus.com/cddw2000/abs/080.htm]. Accessed on: 9 December 2010.</ref> | ||
*Stage 0 - '''no fibrosis'''; "loose" strands of collagen - spaces between collagen bundles. | *Stage 0 - '''no fibrosis'''; "loose" strands of collagen - spaces between collagen bundles. | ||
*Stage 1 - '''minimal fibrosis''' - no fibrous septa, no "portal expansion", i.e. no enlargement of portal area. | *Stage 1 - '''minimal fibrosis''' - no fibrous septa, no "portal expansion", i.e. no enlargement of portal area. | ||
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*Stage 4C - severe cirrhosis - large '''regions of "extinction"''', i.e. loss of normal parenchyma. | *Stage 4C - severe cirrhosis - large '''regions of "extinction"''', i.e. loss of normal parenchyma. | ||
A simplified version:<ref>OA. 10 September 2009.</ref> | |||
*Stage 0 - '''nil; loose strands of collagen'''. | *Stage 0 - '''nil; loose strands of collagen'''. | ||
*Stage 1 - '''irregular (fibrotic) portal area'''. | *Stage 1 - '''irregular (fibrotic) portal area'''. | ||
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Notes: | Notes: | ||
*Many different staging schemes exist. ''Laennec'' is closely related to the ''Metavir'' scheme - which also | *Many different staging schemes exist. ''Laennec'' is closely related to the ''Metavir'' scheme - which also assigns a score of 0-IV. | ||
*There is a review by ''Theise'' focused on viral hepatitis.<ref name=pmid17486049>{{cite journal |author=Theise ND |title=Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach |journal=Mod. Pathol. |volume=20 Suppl 1 |issue= |pages=S3-14 |year=2007 |month=February |pmid=17486049 |doi=10.1038/modpathol.3800693 |url=http://www.nature.com/modpathol/journal/v20/n1s/full/3800693a.html}}</ref> | *There is a review by ''Theise'' focused on viral hepatitis.<ref name=pmid17486049>{{cite journal |author=Theise ND |title=Liver biopsy assessment in chronic viral hepatitis: a personal, practical approach |journal=Mod. Pathol. |volume=20 Suppl 1 |issue= |pages=S3-14 |year=2007 |month=February |pmid=17486049 |doi=10.1038/modpathol.3800693 |url=http://www.nature.com/modpathol/journal/v20/n1s/full/3800693a.html}}</ref> | ||
*''Ishak''<ref name=pmid7560864/> developed a 6-stage system (for research purposes). | *''Ishak''<ref name=pmid7560864/> developed a 6-stage system (for research purposes). | ||