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The scarring of the liver acini (Cirrhosis)

Tridimensional and microcirculatory considerations

Summary

1) Cirrhosis is defined as the scarring of the liver acini in zone 3, zone 1 or in both; the resulting nodules are scarred and modified remnants of acini of various orders. The division of the nodules into “micronodules” and “macronodules” is difficult to justify as their two dimensional appearance changes at different planes of section.

2) Early scar formation precedes changes in the microcirculatory dynamics. Sprouting of vascular branches, especially of arterioles, takes the leading role in the development of mature scars, i.e. offibro-vascular membranes. The fibrous repair is at the same time the road builder for collateral flow.

3) The pathophysiology of the collateral circulation is the basic determinant in the formation of the cirrhotic patterns. The three microcirculatory phases in the cirrhotic process are due to a changeover of the intrahepatic circulatory path from the normal trichotomy of the preterminal vascular branches to convoluted collateral channels. The three phases of the cirrhotic process are:

  1. a.

    The Triadal Nodule. It receives blood from the TPV and THAand from the perinodular plexus. The nodular parenchyma may already be segregated from the ThV, a situation that leads to portal hypertension.

  2. b.

    The Para-triadal Nodule. It is a conglomerate of nodules that often are not completely separated from each other; they are derived from neighbouring acini of various orders which receive blood from large triads contained in the perinodular scar. The blood arrives into the sinusoids primarily via the perinodular plexus. Some sinusoids may receive additional blood through sclerosing remnants of terminal afferent branches and through irregular vascular twigs which, along with septa, enter the nodules at various sites.

  3. c.

    The A-triadal Nodule. It is completely separated from neighbouring nodules by thick scars, its parenchyma totally segregated from afferent and efferent vascular branches. The nodules receive blood only from a dense perinodular plexus of wide capillaries.

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References

  1. Anthony PP, Ishak KG, Nayak NC, Poulsen HE, Scheuer PJ, Sobin LH (1977) The morphology of cirrhosis: Definition, nomenclature, and classifications. Bull WHO 540:521–540

  2. Barone P (1962) Über die Histogenese der ernährungsbedingten Leberzirrhose auf Grund der neueren Erfahrungen über die Blutversorgung der Leber. Frankf Zeitschr Pathol 72:135–154

  3. Bianchi L, de Groote J, Desmet VJ, Gedigk P, Korb G, Popper H, Poulsen H, Scheuer PJ, Schmid M, Thaler H, Wepler W (1977) Acute and chronic hepatitis revisited. The Lancet 8044, Oct 29:914–919

  4. Caulet T, Diebold J, Lavrillier A (1964) Histogenèse des nodules cirrhotiques. Leurs rapports avec les modifications circulatoires intra-hépatiques. Annales d'Anatomie Pathologique 9:77–118

  5. Clausen PP (1980) Alpha-1-antitrypsin globules in liver biopsies. Acta Pathol Microbiol Scand A 88:225–230

  6. Connor CL (1939) Etiology and pathogenesis of alcoholic cirrhosis of the liver. JAMA 112:387–390

  7. Derrick JR (1962) The effect of blood pressure on collateral flow. Am Surg 28:493–500

  8. Gall EA (1960) Posthepatitic, postnecrotic and nutritional cirrhosis: a pathologic analysis. Am J Pathol 36:241–271

  9. Grace ND, Powell LW (1974) Iron storage disorders of the liver. Gastroenterology 67:1257–1283

  10. Hering E (1866) Über den Bau der Wirbeltierleber. Sitzber Akad Wiss Wien, Math-Naturwiss Kl 54:496–515

  11. Hunt AH, Parr RM, Taylor DM (1963) Relation between cirrhosis and trace metal content of the liver with special reference to primary biliary cirrhosis and copper. Brit Med J II:1498–1501

  12. Ito T, Nemoto M (1952) Über die Kupfferschen Sternzellen und die Fettspeicherzellen (fat-storing-cells) in der Blutkapillarwand der menschlichen Leber. Okajimas Folia Anat Jpn 24:243–258

  13. Itoshima T, Yoshino K, Yamamoto K, Munetomo F, Murakami T (1978) Scanning electron microscopy of puncture-perfusion human liver biopsy samples. Observation of bile ductules and bile canaliculi. In: Becker RP, Johari O (eds) Scanning electron microscopy II. AMF O'Hare, Ill, Scan Elect Micros Inc, pp 169–174

  14. Jennings MA, Florey HW (1970) Healing. In: Florey HW General pathology. Philadelphia, London. WB Saunders Co 1970, pp 480–548

  15. Learmonth J (1950) Collateral circulation, natural and artificial. Surg Gynecol Obstet 90:385–392

  16. MacDonald RA (1962) Pathogenesis of nutritional cirrhosis. Arch Int Med 110:424–434

  17. McIndoe AH (1928) Vascular lesions of portal cirrhosis. Arch Pathol Lab Med 5:23–42

  18. Mikkelsen WP, Edmondson HA, Peters RL, Redeker AG, Reynolds TB (1965) Extra- and intrahepatic portal hypertension without cirrhosis (Hepatoportal Sclerosis). Ann Surg 162:602–620

  19. Moschcowitz E (1948) Laennec cirrhosis: its histogenesis with special references to the role of angiogenesis. Arch Pathol 45:187–215

  20. Murakami T, Itoshima T, Shimada Y (1974) Peribiliary portal system in the monkey liver as evidenced by the injection replica scanning electron microscope method. Arch Histol Jpn 37:245–260

  21. Nuber R, Teutsch HF, Sasse D (1980) Metabolic zonation in thioacetamide-induced liver cirrhosis. Histochemistry 69:277–288

  22. Popper H (1977) Pathologic aspects of cirrhosis (review). Am J Pathol 87:228–264

  23. Popper H, Orr W (1970) Current concepts in cirrhosis. Scand J Gastroenterol 5 Suppl 6:203–222

  24. Popper H, Udenfriend S (1970) Hepatic fibrosis. Correlation of biochemical and morphological investigations. Am J Med 49:707–721

  25. Rappaport AM (1960) Betrachtungen zur Pathophysiologie der Leberstruktur. Klin Wochenschr 38:561–577

  26. Rappaport AM (1963) Acinar units and pathophysiology of the liver. In: The liver, Rouiller C (ed) Academic Press, New York, pp 265–328

  27. Rappaport AM (1973) The microcirculatory hepatic unit. Microvas Res 6:212–228

  28. Rappaport AM (1976) The microcirculatory acinar concept of normal and pathological hepatic structure. Beitr Pathol 157:215–243

  29. Rappaport AM (1979) Physioanatomical basis of toxic liver injury. In: Farber E, Fisher MM (eds) Toxic injury of the liver, Part A. Marcel Dekker, Basel, pp 1–57

  30. Rappaport AM (1982) Anatomic considerations. In: Schiff L, Schiff ER (eds) Diseases of the liver, 5th edition Chapter I, Lippincott Co, Philadelphia

  31. Rappaport AM (1983) Physioanatomy of the microcirculation. In: Abramson DI, Dobrin PB (eds) Blood vessels and lymphatics in organ systems, chapter 14, Academic Press Inc, New York (in press)

  32. Rappaport AM, Hiraki GY (1958) The anatomical pattern of lesions in the liver. Acta Anat 32:126–140

  33. Rojkind M, Giambrone MA, Biempica L (1979) Collagen types in normal and cirrhotic liver. Gastroenterology 76:710–719

  34. Rudolph R, McClure WJ, Woodword M (1979) Contractile fibroblasts in chronic alcoholic cirrhosis. Gastroenterology 76:704–9

  35. Straubesand J, Riede UN (1979) Ultrastrukturelle Reaktionsmuster der Gefäßwand mit besonderer Berücksichtigung der Mediamyozyten. In: Ehringer HE, Betz E, Bollinger A, Deutsch E (eds) Gefässwand Rezidivprophylaxe Raynaud-Syndrom. G Witzstrock Verlag, New York

  36. Takahashi T (1978) Three-dimensional morphology of the liver in cirrhosis and related disorders. Virchows Arch [Pathol Anat] 377:97–110

  37. Thoma R (1920) Über die Strömung des Blutes in der Gefässbahn und die Spannung der Gefässwand. Ihre Bedeutung für das normale Wachstum, für die Blutstillung und die Angiosklerose. Beitr z Pathol Anat 66:377–432

  38. Uchida T, Miyata H, Shikata T (1981) Human hepatocellular carcinoma and putative precancerous disorders: their enzyme histochemical study. Arch Pathol Lab Med 105:180–186

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Author information

Correspondence to M. M. Fisher.

Additional information

Supported by the Atkinson Foundation, the Oxford Liver Research Foundation and the Canadian Liver Foundation

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Rappaport, A.M., MacPhee, P.J., Fisher, M.M. et al. The scarring of the liver acini (Cirrhosis). Vichows Archiv A Pathol Anat 402, 107–137 (1983). https://doi.org/10.1007/BF00695054

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Key words

  • Nodular microcirculation and morphology
  • Intrahepatic collaterals
  • Functions of liver scars
  • roadbuilders of collateral flow
  • Definition of cirrhosis