人类肝硬化的回归：在Wanless等人的开创性文章18年后的更新

StephenW

Virchows Arch. 2018 Mar 27. doi: 10.1007/s00428-018-2340-2. [Epub ahead of print]
Regression of human cirrhosis: an update, 18 years after the pioneering article by Wanless et al.Hytiroglou P1, Theise ND2.
Author information
1Department of Pathology, Aristotle University Medical School, 54006, Thessaloniki, Greece. [email protected].2Department of Pathology, New York University School of Medicine, 550 First Avenue, TH415, New York, NY, 10016, USA.

AbstractCirrhosis has been traditionally viewed as an irreversible, end-stage condition. Eighteen years ago, Wanless, Nakashima, and Sherman published a study that was based on the concept that hepatic architecture is under constant remodeling in the course of chronic liver diseases, even during their most advanced stages; depending on the balance between injury and repair, the histologic changes might be progressing or regressing. These authors described in detail the morphologic features of regressing cirrhosis, identified a set of histologic features of regression that they called the "hepatic repair complex," and provided convincing morphologic evidence that incomplete septal cirrhosis represents regressed cirrhosis. In the years that followed publication of this pioneering article, a number of clinical studies with performance of pre- and post-treatment liver biopsies provided abundant evidence that cirrhosis can regress after successful therapy of chronic hepatitis B, chronic hepatitis C, autoimmune hepatitis, and genetic hemochromatosis. Evidence for other chronic liver diseases may also be provided in the future, pending ongoing studies. Successful therapy allows resorption of fibrous septa, which can be followed by loss of nodularity and architectural improvement; however, many vascular lesions of cirrhotic livers are not thought to regress. Cases of cirrhosis that are considered more likely to improve than others include those of recent onset, with relatively thin fibrous septa and mild vascular changes. Histologic examination of liver biopsy specimens from patients with chronic liver diseases provides the opportunity to appreciate the features of the hepatic repair complex on a routine diagnostic basis; however, interpretation is often difficult, and can be aided by immunohistochemical stains. Clinicopathologic correlation is essential for a meaningful assessment of such cases. For many patients, cirrhosis is not an end-stage condition anymore; therefore, use of the term "cirrhosis" has been challenged, almost 200 years after its invention. However, regression of cirrhosis does not imply regression of molecular changes involved in hepatocarcinogenesis; therefore, surveillance for hepatocellular carcinoma should be continued in these patients.


KEYWORDS: Cirrhosis; Incomplete septal cirrhosis; Regression; Vascular lesions

PMID:29589101DOI:10.1007/s00428-018-2340-2

StephenW

Virchows Arch。 2018年3月27日doi：10.1007 / s00428-018-2340-2。 [电子版提前打印]
人类肝硬化的回归：在Wanless等人的开创性文章18年后的更新。
Hytiroglou P1，Theise ND2。
作者信息

1
    希腊塞萨洛尼基54006亚里士多德大学医学院病理系。 [email protected]。
2
    纽约大学医学院病理系，美国纽约州纽约市TH415第一大街550号，10016，美国。

抽象

传统上，肝硬化被视为不可逆转的终末期病症。 18年前，Wanless，Nakashima和Sherman发表了一项研究，该研究基于肝脏结构在慢性肝病过程中不断重塑的概念，即使在最高阶段也是如此;取决于损伤和修复之间的平衡，组织学变化可能正在发展或退化。这些作者详细描述了退化性肝硬化的形态学特征，发现了一组称为“肝脏修复复合体”的组织学退化特征，并提供了令人信服的形态学证据表明不完全的间隔性肝硬化代表退化性肝硬化。在这篇开创性文章发表之后的几年中，许多具有治疗前和治疗后肝活检表现的临床研究提供了大量证据，证明成功治疗慢性乙型肝炎，慢性丙型肝炎，自身免疫性肝炎后肝硬化可以退化，遗传性血色病。在未来的研究中，未来还可能提供其他慢性肝病的证据。成功的治疗可以吸收纤维间隔，然后可以丧失结节和改善结构;然而，肝硬化肝脏的许多血管病变并不认为会退化。被认为比其他人更容易改善的肝硬化病例包括近期发病的肝硬化病人，纤维间隔相对较薄，血管轻度改变。慢性肝病患者肝组织活检标本的组织学检查提供了在常规诊断的基础上了解肝脏修复复合体特征的机会;然而，解释通常是困难的，并且可以通过免疫组织化学染色辅助。临床病理学相关性对于对此类病例进行有意义的评估至关重要。对于许多患者来说，肝硬化不再是终末期病症，因此，使用术语“肝硬化”在其发明差不多200年后就受到了挑战。然而，肝硬化的消退并不意味着肝癌发生中涉及的分子变化的消退;因此，这些患者应继续监测肝细胞癌。
关键词：

肝硬化;不完全性间隔性肝硬化;回归;血管病变

结论：
    29589101
DOI：
    10.1007 / s00428-018-2340-2