Liver is, of course, a most important organ biochemically and physiologically, and if we consider the wide range of diseases involving liver, the importance must be emphasized again in pathological field. But still the etiology and/or pathogenesis of some hepatic lesions especially cirrhosis have not been clearly
understood, and so confusion on the exact classification of liver diseases have not hitherto been solved. Furthermore, in the clinical aspect, the performance of needle biopsy has been rising for the physicians' needs to confirm the provisional impression by tissue diagnosis. Therefore difficulty in the diagnosis of the needle biopsied liver tissues has become problem to the pathologists. Meanwhile, in Korea, in spite of the high incidence of liver diseases probably due to the average low protein diet which would result in decreased stats of liver function, results of other races who are different in cultural and environmental back ground have been cited because of the rarity of exact records on the whole liver diseases among Koreans.
Considering the above subjects, this study is to classify liver diseases morphologically observing the incidence of each, to examine the histological activity of the cirrhosis, and to research, in morphological basis, the frequent occurrence of primary liver carcinoma.
Materials and Methods
The materials used in this study consisted of 951 liver biopsies obtained during the period from Jan. 1960 to Jun. 1971.
For histologic studies, the 10% formalin fixed specimens were followed by paraffin embedding and were cut in 6 u thickness. Sections were stained with hematoxylin-eosin for routine examination, and the biopsies obtained since May, 1970 were all stained with beside hematoxylin-eoisn Gomori's silver impregantion for lobular architecture and reticulate pattern, Masson's trichrome for connective tissue and PAS for glycogen content of the liver cells and mucopolysaccharide of bile duct epithelium. Stains for bile or iron were also done in cases of needs.
Histological classification were made as follows for the usefulness, especially interpretation of the needle biopsied liver tissues.
Diffuse hepatitis Acute viral hepatitis
Chronic active hepatitis
Inflammation due to biliary obstruction
Nonspecific reactive hepatitis
Liver cirrhosis Macronodular cirrhosis well differentiated
Neoplasm Benign Primary Hepatocellular
Malignant Carcinoma Metastatic carcinoma
Anaplastic Cholangi ??
Sarcoma Hope tobla ??
Biopsies showing morphologically the probability of various drug induced hepatitis or chronic persistent hepatitis were all comprised in nonspecific reactive hepatitis of Schaffner and Popper(1959), because it is thought that no one could exactly confirm the two disease entities unless detailed records on the
patients were available. On the macronodular cirrhosis, the degree of differentiation was determined according chiefly to the evidence of parenchymal collapse or not, and to the nodules in which there was resemblance of lobular structure and in which portal tracts and efferent veins were identifiable or not. Based on the criteria of Popper et al. (1965), activity of the macro-and micronodular cirrhosis was also examined,
which was them closely compared with serum transaminase level.
Neoplasm was subclassified solving the commonly used methods, but hepatoblastoma was included to the primary carcinoma of the liver and was subclassified as epithelial type and mixed type(Ishak & Crunz, 1967; Ito & Johnson, 1969). Combined
or associated pathological entities of the primary liver carcinoma were also examined.
Congenital liver diseases, including intra-or extrahepatic biliary atresia, localized diseases, passive congestion, fatty metamorphosis, clonorchiasis etc. were all comprised in the miscellaneous category, because mainly of their specificity and rarity.
Clinical report and laboratory data were reviewed on the cases obtained from Jan. 1967 to Jun. 1971, and compared with each tissue finding.
Results and summary
Histopathological and clinical studies were made on 951 liver biopsies submitted to the Department of Pathology, Yonsei University College of Medicine, during the period from Jan. 1960 to Jun. 1971, and the results were as follows.
1. Among 951 liver biopsies, excluding insufficient and normal tissues, 795 cases were helpful for this study, marking 83.6% of total cases. Of the 975, 631 cases were male and 164 were female, representing the sex ratio of 3.8:1 respectively.
2. Big three hepatic diseases involving liver biopsies in Korea were diffuse hepatitis, liver cirrhosis and neoplasm, marking 28.7%, : 24.3% and 21.7% respectively, and sum of 74.7%.
3. Neoplasm of the liver was found in 206 cases (21.7%) in which only 20 cases were metastatic and most of the remainders were primary carcinoma. In primary carcinoma, the ratio of male and female was 5.1 : 1, and histopathologically hepatocellular type was predominant, representing 60.7% of all neoplasms.
4. 24 cases of primary hepatocellular carcinoma showed, as associated pathological findings, cirrhotic changes which were mostly regarded as macronodular well differentiated cirrhosis. And although none of cholangiocarcinoma was combined with cirrhosis, 3 cases among 7 were associated with histologic changes usually found in clonorchiasis.
5. Cirrhosis was found in 231 cases, 149 of them (64.9%) were regarded as macronodular and 45 as micronodular cirrhosis.
6. Histologic activity was found in 74 cases of macro-and 30 cases of micronodular cirrhosis. And the active one tended to show more frequently the serum transaminase level of more than 40 unit/cc.
7. But the degree of increment in serum transaminase was not so remarkable even in the active form of cirrhosis, and hence it was considered that piece-meal necrosis would be progressed slowly and step by step.
8. Neonatal hepatitis was found in 13 cases and of them only 8 showed giant cell transformation of liver cells.
9. Of miscellaneous liver diseases, abscess ranked the first, most of which were regarded as nonspecific. And only granulation tissue, pus, or collagenous wall was the frequent finding of the needle biopsied abscess tissue.
In conclusion, it can be stated that in comparison to liver diseases of Europeans and Americans, those among Korean examined on biopsied specimens exhibited quite different incidence, which may be the result of unusually high occurrence of primary carcinoma, and also stated that clonorchiasis, a common disease among Korean, is closely related to the cholangiocarcinoma, and that the elevation of serum transaminase may be used for the clinical activity of cirrhosis.