Reversibiliteit van cirrose

Reversibiliteit van cirrose
Joanne Verheij, MD, PhD
Department of Pathology
Academic Medical Center
Amsterdam
Disclosure
Geen (potentiële) belangenverstrengeling
Liver acinus, normal architecture
Zone 1: surrounds portal tract
Zone 3: surrounds central vein
Metavir
F1
F0
F3
Faria SC, RSNA 2009
F2
F4
Standish, Gut 2006 “An appraisal of the histopathological assessment of liver fibrosis”
CIRROSE
René Laënnec (1781-1826) in “De l’auscultation médiate ou Traité du Diagnostic
des Maladies des Poumons et du Coeur’’(1819).
“Le foie réduit au tiers de son volume se trouvait caché dans la
région qu’il occupe; incisé, il paraissait entièrement composé d’une
multitude de grains de la grosseur d’un frain de chènevis ou de
millet, de couleur jaune ou jaune roux.”
Histopathology, April 2013
75/139 (49%) reversal of cirrhosis (n=23 F3; n= 26 F2, n= 23 F1 and n= 3 F0)
~ age !
Lancet 2013
Limitations
Biopsy length
Sampling error
Interobserver variability
Inclusion criteria (compensated vs decompensated liver disease)
Correlation decrease histological stage with outcome (liver
related disease, portal hypertension and occurrence HCC)?
“cirrhosis is more than just widespread liver fibrosis”….
“…cirrhosis is indeed basically a vascular disease….”
Determinants of irreversiblity:
-
persistence and intensity initiating injury
-
morphological characteristics nodules and septa: cross-linking collagen, elastin-rich scars
-
vascular remodeling: neoangiogenesis, sinusoidal capillarization, loss of metabolic zonation
Cirrhosis encompasses a pathological spectrum, being dynamic and
bidirectional
Point at which cirrhosis is irreversible not established yet!
Hepatic repair complex
Hytiroglou P et al. Beyond "cirrhosis": a proposal from the International Liver
Pathology Study Group. Am J Clin Pathol. 2012
Simple semiquantitative fibrosis score not adequately represents complexity
of the pathophysiological process leading to cirrhosis.
A classification of cirrhosis based on key pathogenetic mechanisms reflecting
the complexity of the disease rather than just fibrosis becomes now
fundamental..
Liver biopsy in the advanced phase of disease: quantitative/morphometric
methods for more precise prognostic information?