Abstract

Liver is, of course, a most important organ biochemically and physiologically, and if we consider the wide range of diseases involving the 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 classification of liver cirrhosis has not hither to 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 a 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 states of the liver function, results of other races who were different in cultural and environmental back ground have frequently been cited because of the rarity of exact records on the whole liver diseases among Koreans. Considering the above subjects, this study is to provide the incidence of liver diseases and to ensure the frequent occurrence of primary liver carcinoma in Korea, on morphological basis 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 specimens filed with 10% formalin were followed by paraffin embedding and were cut in 6 μ thickness. Sections were stained with hematoxylin-eosin for routine examination, and the biopsies obtained since May, 1970 were all stained with in addition to hematoxylin-eosin, Gomori’s silver impregnation for lobular architecture and reticulin pattern and Masson’s trichrome for connective tissue. Stains for bile or iron were also done in cases of needs. Histopathological classification was made as follows for convenience, 1. diffuse hepatitis, 2. liver cirrhosis, 3. neoplasm and 4. miscellaneous diseases. Diffuse hepatitis included acute hepatitis, chronic active and inactive hepatitis, cholangiolitis neonatal hepatitis and nonspecific reactive hepatitis of Schaffner and Popper (1957, 1959) Liver cirrhosis was subclassified as macronodular, micronodular cirrhosis and biliary cirrhosis by the size and shape of the cirrhotic nodules(Popper and Schaffner, 1968; Scheuer, 1970). On the macronodular cirrhosis, the degree of differentiation was made according chiefly to the evidence of parenchymal collapse or not, whether the cirrhotic nodules revealed resemblance of lobular pattern, and to whether the portal tracts and efferent veins could be identified or not. Based on the criteria of Popper et al. (1965), activity of the macro- and micronodular cirrhosis was also examined, which was then closely compared with serum transaminase level. Hepatoblastoma was inc]used to the primary carcinoma of the liver and was subclassified as epithelial type and mixed type (Ishak and Grunz, 1967 ; Ito and Johnson, 1969). Combined or associated pathology of the primary liver carcinoma was also examined. Congenital liver diseases, including intra- or extrahepatic biliary atresia, passive congestion, fatty metamorphosis, clonorchiasis and granulomatous diseases were all comprised in the misce]laneous category, because of their rarity. Clinical records and laboratory data were reviewed and compared with the tissue findings.
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, 827 (87%) cases were available for the study, excluding insufficient tissues. And big three hepatic diseases in Korea based on biopsy were diffuse hepatitis, liver cirrhosis and neoplasm, marking 33.0%, 27.9% and 24.8% respectively with the sum of 85.7%. 2. Diffuse hepatitis was encountered in 273 cases with the sex ratio of 2.5 : 1 and the average age of 41.5 year-old. More than half (141 cases) of the diffuse inflammatory lesions were chronic inactive and nonspecific reactive hepatitis. In contrast, acute hepatitis diagnosed by the tissue pathology was far less common (28 cases) and it was likely the cause that acute viral hepatitis was somewhat conventional clinically and the biopsy was frequently contraindicated when the patient was in icteric state. 3. Neonatal hepatitis was found in 13 cases and of them only 8 showed giant cell transformation of the liver cells. 4. Cirrhosis was encountered in 231 cases with the sect ratio of 5.2 : 1 and the average age of 48.8 year-old. 149 cases(64.9%) were regarded as macronodular and 45(19.5%) as micronodular cirrhosis. 5. 74 cases of macro-and 30 cases of micronodular cirrhosis were histologically active and the active one tended to show-more frequently the serum transaminase level of higher than 40 unit/cc. But the degree of increment in serum transaminase was not so remarkable even in the active form of cirrhosis, suggesting that piece-meal necrosis might be progressed slowly and step by step. 6. Neoplasm of the liver was diagnosed in 206 cases, 134 (65.0%) being primary carcinoma and most of the remainders metastatic tumor and anaplastic carcinoma. In primary carcinoma. male was far more commonly affected than female with the ratio of 5.1 : 1 and the mean age was 48.4 year old. Histopathologically 12.5 cases (60.7%) were hepatocellular and only 7 were bile duct type of carcinoma. 7. 24 cases of primary hepatocellular carcinoma showed, as associated pathological findings, cirrhotic changes which were mostly regarded as macronodular well differentiated. Although none of the seven cholangiocarcinoma was combined with cirrhosis, three of them were associated with histologic changes usually found in clonorchiasis. 8. Of the miscellaneous liver diseases, abscess ranked the first, most of which were regarded as nonspecific. And granulation tissue, pus, or collagenous wall was the only finding frequently observable in the needle biopsied tissue from abscess. In conclusion, it can be stated that in comparison to liver diseases of Europeans and Americans, those among Koreans examined on biopsied specimens exhibited quite different incidence, which may be the result of unusually high occurence of primary carcinoula of the liver, and that clonorchiasis, a common disease among Koreans, is closely related to the cholangiocarcinoma, and that the elevation of serum transaminase may be used for the clinical activity of liver cirrhosis.