Pathology Outlines - Cirrhosis - features to report

Liver and intrahepatic bile ducts - nontumor
General concepts
Cirrhosis - features to report

Author: Anthony W.H. Chan, F.R.C.P.A.

Topic Completed: 1 April 2017

Revised: 23 January 2019, last major update April 2017

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Cirrhosis[TI] features to report

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Table of Contents

Definition / general

Cite this page: Chan A. Cirrhosis - features to report. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/livercirrhosisreport.html. Accessed June 18th, 2019.

Definition / general

Diagnosis: incomplete cirrhosis (Ishak stage 5) vs. probable / definite cirrhosis (Ishak stage 6) (J Hepatol 1995;22:696)
Subclassification: micronodular (< 3 mm) vs. macronodular (≥ 3 mm)
- Classically but not very clinically significant
- Former is more commonly associated with alcoholic liver disease, genetic hemochromatosis and Wilson disease, whereas the later is more frequently associated with viral hepatitis
- Micronodular cirrhosis and macronodular cirrhosis may be transformed in either way depending on disease activity (Arch Pathol Lab Med 2000;124:1599)
- Difficult to assess in liver biopsy specimen
Subclassification: Laennec fibrosis scoring system (J Hepatol 2011;55:1004)
- 4A: mild cirrhosis; marked septation with rounded contours or visible nodules; most septa are thin (one broad spectum allowed)
- 4B: moderate cirrhosis with at least two broad septa
- 4C: severe cirrhosis with at least one very broad septum or many minute nodules
- Excellent interobserver agreement (kappa 0.83)
- Correlate with severity of portal hypertension and Child-Pugh and MELD scores
Etiology
- Clinical, biochemical and serological correlation is essential
- Cryptogenic (idiopathic) cirrhosis accounts for 8 - 9% of liver transplants in the US; "burnt out" NAFLD / NASH is a common cause of cryptogenic cirrhosis (Hepatology 2000;32:689)