Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Adv Anat Pathol. 2012 Jul;19(4):220-30. doi: 10.1097/PAP.0b013e31825c6bab.
In current medical practice, the clinical diagnosis of cirrhosis is rendered when a patient has suggestive imaging findings or features of portal hypertension (pHTN). Liver biopsy may be considered to assess potential underlying cause(s). Cirrhosis, however, is not the only etiology of pHTN; in fact, schistosomiasis remains a significant factor worldwide. pHTN results from obstruction of hepatic blood flow; it is classified clinically based on either the anatomic location of obstruction or hepatic venous pressure gradient measurements. The clinical categories carry clinicopathologic significances. Histopathologically, pHTN is manifest with either cirrhotic or noncirrhotic features. Noncirrhotic pHTN results from a heterogeneous group of disease processes, all of which result in vascular remodeling with variable parenchymal nodularity and fibrosis. This review summarizes liver biopsy findings of cirrhosis and possible etiologies and provides a stepwise approach for the histologic differential diagnosis of a liver biopsy done for "cirrhosis."
在当前的医学实践中，当患者出现提示性影像学发现或门静脉高压（pHTN）特征时，即可做出肝硬化的临床诊断。可能会考虑进行肝活检以评估潜在的潜在病因。然而，肝硬化并不是 pHTN 的唯一病因；实际上，血吸虫病仍然是全球的一个重要因素。pHTN 是由于肝血流阻塞引起的；它根据阻塞的解剖位置或肝静脉压力梯度测量值在临床上进行分类。临床分类具有临床病理意义。组织病理学上，pHTN 表现为肝硬化或非肝硬化特征。非肝硬化性 pHTN 由一组异质性疾病过程引起，所有这些疾病都会导致血管重塑，伴有不同程度的实质结节和纤维化。本文综述了肝硬化的肝活检结果及其可能的病因，并为因“肝硬化”而行肝活检的组织学鉴别诊断提供了一种逐步的方法。
