Importance of terminal hepatic venule thickening

Thickening around the terminal hepatic venule (THV) in alcoholics has been implicated as a marker for fibrosis and cirrhosis. To test this hypothesis, we evaluated 107 liver biopsy specimens from patients with normal liver histologic features (12), fatty livers (30), mild alcoholic hepatitis (15), and florid alcoholic hepatitis (29). Twenty-one follow-up liver biopsy specimens from patients with fatty liver and alcoholic hapatitis were also available for this study. Two observers (S.M.N., V.H.N.) graded 18 histologic features on a scale of 0 to 3. There was no significant difference in the prevalence of THV thickening in normal biopsy specimens and in various forms for alcoholic liver injury. There was also no correlation between the degree of THV thickening and steatosis, necrosis, or inflammation. Thickening of the THV was most common in the presence of lobular and subsinusoidal fibrosis. Cirrhosis developed in nine of ten alcoholic patients who had subsinusoidal and lobular fibrosis. These findings illustrate that the marker for progressive fibrosis and development of cirrhosis is lobular and subsinusoidal fibrosis and not the isolated thickening of the THV.