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Reversibiliteit van cirrose
Joanne Verheij, MD, PhD
Department of Pathology
Academic Medical Center
Amsterdam
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Disclosure
Geen (potentiële) belangenverstrengeling
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Liver acinus, normal architecture
Zone 1: surrounds portal tract
Zone 3: surrounds central vein
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Metavir
F0
F4F3
F2F1
Faria SC, RSNA 2009
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Standish, Gut 2006 “An appraisal of the histopathological assessment of liver fibrosis”
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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.”
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Histopathology, April 2013
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75/139 (49%) reversal of cirrhosis (n=23 F3; n= 26 F2, n= 23 F1 and n= 3 F0)
~ age !
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Lancet 2013
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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)?
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“cirrhosis is more than just widespread liver fibrosis”….
“…cirrhosis is indeed basically a vascular disease….”
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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!
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Hepatic repair complex
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Hytiroglou P et al. Beyond "cirrhosis": a proposal from the International Liver
Pathology Study Group. Am J Clin Pathol. 2012
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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?
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