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Five autopsy cases showing more than 20 hepatocellular mitotic figures per 1cm2 of liver parenchyma had also widespread skeletal muscle necrosis and renal failure. Myoglobin casts in renal tubules were remarkable. In three of these cases liver cell damage was obvious, but in two others it was negligible. Mechanisms of muscle necrosis were probably different from case to case. For a control study, 32 autopsy cases were selected on the basis of underlying diseases such as acute or chronic liver disease, acute or chronic renal failure, polymyositis with or without muscle necrosis at autopsy, etc., and the frequency of hepatocellular mitosis was measured. All the control cases had less than 5 mitoses per 1cm2 of liver parenchyma. In cases showing muscle necrosis in the control study, it was considerably less severe than that in the cases showing numerous mitoses. The present study confirms that the appearance of a considerable number of hepatocellular mitoses is an unusual finding even in conditions in which it might be expected, and is independent of liver cell damage. In some cases it might be related to widespread muscle necrosis. It is suggested that pathologists should examine muscles histologically whenever they observe numerous liver cell mitoses in autopsy cases. The nature and significance of an excess of hepatocellular mitoses at autopsy, whether due to the actual induction of mitotic activity, or representing the accumulation of mitotic figures as the result of the inhibition of cell division after death are discussed in relation to muscular necrosis.

A study of the frequency of hepatocellular mitotic figures in human autopsy cases.