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Formation and clinical significance of reddish markings on the liver surface: Activity of chronic liver disease
Author(s) -
SHIBAYAMA TAKAO,
OHTAKE HIROO,
HISHIMA TSUNEKAZU
Publication year - 2003
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1046/j.1443-1661.2003.00225.x
Subject(s) - medicine , cirrhosis , pathology , parenchyma , fibrous capsule of glisson , capsule , liver biopsy , lesion , chronic liver disease , liver disease , hepatitis , biopsy , biology , botany
Background: The aim of this study was to clarify the clinical significance of reddish markings appearing on the surface of the liver. Methods: Subjects were patients with Hepatitis B virus‐related ( n = 232) or Hepatitis C‐related ( n = 246) chronic liver disease. Reddish lesions were obtained from this population using punch biopsy ( n = 30) or wedge biopsy ( n = 4), then studied histopathologically. In addition, the incidence and macroscopic forms of reddish markings in each laparoscopic stage for the 478 subjects were examined to determine when reddish markings appeared. Results: Reddish markings on the liver surface appeared only after the appearance of hepatic parenchymal destruction subjacent to the liver capsule, rather than with the appearance of piecemeal necrosis in the portal area. Moreover, following expansion of necrotic hepatic parenchyma subjacent to the liver capsule and distortion of hepatic lobular architecture in this lesion, net‐like or hemorrhagic fleck‐like reddish markings appeared. Therefore, this was recognized as changes at the liver capsule, such as capillary proliferation and dilatation, and blood flow changes in both the capsule and hepatic parenchymal lesions subjacent to the liver capsule. With regards to timing, reddish markings were most frequently observed in the transition to liver cirrhosis. After the appearance of reddish markings on the liver surface, chronic hepatitis rapidly progressed to liver cirrhosis. Conclusion: Reddish markings correspond to hepatic parenchymal destruction subjacent to the liver capsule, and not to piecemeal necrosis. Reddish markings appear in the transition to liver cirrhosis and might offer a useful marker of the progression to liver cirrhosis.