[Clinical significance and histological classification of atrophy/hypertrophy complexes of the liver]
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W Schweizer1, G Schott, A Zimmermann
1Universitätsklinik für viszerale und Transplantationschirurgie, Universität Bern, Inselspital Bern.
Insights
Obstruction of liver blood vessels causes the atrophy/hypertrophy complex (AHC). Early diagnosis and a precise pathway are crucial for effective therapy planning and improved prognosis in AHC patients.
Area of Science:
- Hepatology
- Radiology
- Gastroenterology
Context:
- Biliary, portal, biliary/portal, and hepatovenous obstruction are etiological factors for liver atrophy/hypertrophy complex (AHC).
- 30 patients with significant AHC were evaluated between 1987 and 1990.
- Evaluation involved an interdisciplinary team of specialists.
Purpose:
- To present the diagnostic pathway for liver atrophy/hypertrophy complex (AHC).
- To introduce a new histological classification for AHC.
- To emphasize the importance of early AHC recognition for therapy and prognosis.
Summary:
- Ultrasound was the initial diagnostic step in 29 patients, followed by CT in 26.
- Further investigations included scintigraphy (21), ERCP/angiography (14), and PTC (8).
- Etiologies included post-cholecystectomy stricture (12), tumors (9), and other conditions (9).
Impact:
- Severe histological changes indicate a worse prognosis, even in benign liver diseases.
- Precise diagnostic pathways are essential for successful therapy planning.
- Early recognition of AHC is vital for patient outcomes.
Abstract:
Biliary, portal, biliary/portal and hepatovenous obstruction have been recognized as the etiological factors leading to the atrophy/hypertrophy complex (AHC) of the liver. From 1987 to 1990 30 patients were evaluated in our department with documented significant AHC of the liver. The evaluation of these patients was performed at an interdisciplinary meeting of surgeons, gastroenterologists, radiologists and hepatologists. All patients were studied in regard to clinical, radiological and gastroenterological investigations, intraoperative findings and histology. We present the diagnostic pathway, which included ultrasound in 29 patients as the first diagnostic step and 26 patients in whom computed tomography was added. In 21 patients hepato-iodide scintigraphy was performed, in 14 patients ERCP and angiography, and in 8 patients PTC. Etiologically we found in 12 patients a post-cholecystectomy stricture (PCS) in 12 patients, a tumour obstruction in 9 patients, different etiologies (Echinococcus, Budd-Chiari syndrome, primary biliary cirrhosis [PBC], Mirizzi-syndrome) in 9 patients and an unclear etiology in 4 patients. On the basis of our study we present a new histological classification of the AHC. Severe histological changes were prognostically worse, even in benign diseases. Therapy planning is always dependent on a very precise diagnostic pathway and early recognition of AHC is essential for the planning of therapy and for the prognosis of the disease.