Hepatocellular carcinoma (HCC) frequently occurs in association with liver cirrhosis, as chronic liver disease is one of the most important factors in carcinogenesis. In addition to HCCs, recent reports of pathologic studies of resected specimens from cirrhotic liver describe associated small nodular lesions such as regenerative nodule, dysplastic nodule (adenomatous hyperplasia), and dysplastic nodule with subfocus of HCC (early HCC). In hepatocarcinogenesis of the cirrhotic liver, a regenerative nodule might be the first step in the development of HCC, going through phases of dysplastic nodule, early HCC and early advanced HCC in a multistep fashion. Fortunately, recent advances in various imaging techniques have facilitated the verification of these nodules. In this review, new nomenclature of small hepatocellular nodules, and detection and characterization of hepatic nodules in carcinogenesis with various imaging techniques are described with focus on the premalignant lesions and early stage of HCC. In addition, the efficacy of various imaging techniques for diagnosing them is discussed. Although the terms and definitions of these nodules are still variable and controversial, familiarity with the concept of these borderline lesions is important.
Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/diagnosis* ; Carcinoma, Hepatocellular/complications ; Diagnostic Imaging*/methods ; Human ; Liver Cirrhosis/pathology ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/complications ; Patient Care Management ; Terminology

No abstract available.
Carcinoma, Hepatocellular/*diagnosis/pathology ; Hepatitis B/complications/*diagnosis ; Humans ; Liver Cirrhosis/complications/*pathology ; Liver Neoplasms/*diagnosis/pathology ; Male ; Middle Aged

Biomarkers ; blood ; Biopsy, Needle ; utilization ; Hepatitis C ; complications ; Humans ; Liver ; pathology ; Liver Cirrhosis ; diagnosis ; pathology

Esophageal and Gastric Varices ; diagnosis ; etiology ; pathology ; Hemorrhage ; Humans ; Liver Cirrhosis ; complications ; pathology

Acute-on-chronic liver failure (ACLF) is an increasingly recognized distinct disease entity encompassing an acute deterioration of liver function in patients with chronic liver disease. Although there are no widely accepted diagnostic criteria for ACLF, the Asia.Pacific Association for the Study of the Liver (APASL) and the American Association for the Study of Liver Disease and the European Association for the Study of the Liver (AASLD/EASL) consensus definitions are commonly used. It is obvious that the APASL and the AASLD/EASL definitions are based on fundamentally different features. Two different definitions in two different parts of the world hamper the comparability of studies. Recently, the EASL-Chronic Liver Failure Consortium proposed new diagnostic criteria for ACLF based on analyses of patients with organ failure. There are areas of uncertainty in defining ACLF, such as heterogeneity of ACLF, ambiguity in qualifying underlying liver disease, argument for infection or sepsis as a precipitating event, etc. Although the exact pathogenesis of ACLF remains to be elucidated, alteration of host response to injury, infection, and unregulated inflammation play important roles. The predisposition, infection/inflammation, response, organ failure (PIRO) concept used for sepsis might be useful in describing the pathophysiology and clinical categories for ACLF. Treatment strategies are limited to organ support but better understanding of the pathophysiology is likely to lead to discovery of novel biomarkers and therapeutic strategies in the future.
Chronic Disease ; Echocardiography ; Humans ; Liver Cirrhosis/complications ; Liver Failure/diagnosis/etiology/*pathology/prevention & control ; Liver Failure, Acute/diagnosis/etiology/*pathology/prevention & control ; Liver Transplantation ; Sepsis/complications

Non-typhoidal salmonellosis, which is increasing nowadays in Korea as well as in the developed countries, is manifested as enteritis in most cases, but it also encompasses bacteremia, intraabdominal infections, and bone, joint and soft tissue infections. These rare diseases are known to result from primary gastrointestinal infection and subsequent bacteremia with or without symptoms. We experienced a case of neck abscess caused by Salmonella serotype D, which is a rare but important differential diagnosis of neck abscess. We herein report it.
Abscess/*diagnosis/*microbiology ; Aged ; Female ; Humans ; *Liver Cirrhosis ; Neck/*microbiology/*pathology ; Salmonella/*physiology ; Salmonella Infections/*complications

BACKGROUNDThe natural history of liver cirrhosis in China has not been well understood. This study aimed to elucidate the profile and development of the complications of liver cirrhosis as well as the mortality of those cirrhotics with miscellaneous complications.

METHODSWe assembled data from the clinical characteristics, especially from the profile complications of cirrhosis on admission, and collected information by telephone or interview with patients and/or their family members in clinic to evaluate the development of complications in 920 patients enrolled in a prospective non-randomized cohort study, and followed up from June 2006 to October 2010. Mortality was calculated using Kaplan-Meier analysis and Cox regress analysis. We employed both of the Child-Pugh scoring system and model for end-stage liver disease (MELD) scoring system to compare with the accordance and veracity between liver function and the long-term outcome.

RESULTSOn admission, only 7.4% patients had no complications, 44.5% patients with one complication (ascites, esophageal/gastric varices or hepatocellular carcinoma), 33.8% patients with two coexisting complications, and 7.5% patients had complications concurrently with ascites, esophageal/gastric varices and hepatocellular carcinoma. During the follow-up (mean follow-up time was 17 months, ranging from 1.0 to 52.2 months) of all the patients, 37.5% patients survived without new complications, 62.5% patients had new complications, and the overall mortality was 53.9%. Patients with one or more complications had higher mortality (total mortality, 1-year or 3-year mortality) and shorter mean survival time than those without any complication; the major cause of mortality of these cirrhotic patients was hepatocellular carcinoma (59%). Evaluated with the Child-Pugh score system, the total mortality in those with the scores more than 12 (class C) was 71.4%, the 1-year and 3-year mortalities were 57.1% and 71.4% respectively; while evaluated with the MELD scoring system, the mortality of those with the scores more than 30 was 58.6%, the 1-year and 3-year mortalities were 44.2% and 57.8% respectively.

Adult ; China ; Female ; Humans ; Liver Cirrhosis ; complications ; diagnosis ; mortality ; pathology ; Male ; Middle Aged

OBJECTIVETo analyze the clinical and pathological characteristics of primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH) overlap syndrome.

METHODSOf our 68 patients with the diagnosis of PBC, we identified 9 overlap syndrome cases strictly using the revised descriptive criteria and scoring system for diagnosis of AIH proposed by the International Autoimmune Hepatitis Group Report. The clinical manifestations and pathological changes shown in liver biopsies from the overlap syndrome and pure PBC were analyzed and compared.

RESULTSThe mean aggregate scores of the 9 cases (13.2%) of the overlap syndrome group and 59 cases of pure PBC (86.8%) were 10.2+/-0.2 and 4.7+/-0.7 respectively among the 68 total. The serum levels of ALT and AST, immunoglobulin G, gammaglobulin, in the overlap syndrome group were significantly higher than those in the pure PBC group, and also there was a frequent presence of antinuclear antibody and/or smooth muscle antibody positivity in the overlap syndrome group. Histopathologically the livers in the overlap syndrome group showed combined features of interface hepatitis and piecemeal necrosis, characterizing the two diseases.

CONCLUSIONThe overlap syndrome group showed combined features of both PBC and AIH. There were differences in clinical aspects, serology and histology between the overlap syndrome and pure PBC groups.

Adult ; Female ; Hepatitis, Autoimmune ; complications ; diagnosis ; pathology ; Humans ; Immunoglobulin G ; blood ; Liver ; pathology ; Liver Cirrhosis, Biliary ; complications ; diagnosis ; pathology ; Male ; Middle Aged ; Retrospective Studies

No abstract available.
Diagnosis, Differential ; Focal Nodular Hyperplasia/etiology/*pathology/surgery ; Hepatectomy ; Humans ; Liver Cirrhosis/complications/*diagnosis/pathology ; Male ; Middle Aged

Visceral leishmaniasis (VL) is a life-threatening infection caused by Leishmania species. In addition to typical clinical findings as fever, hepatosplenomegaly, and cachexia, VL is associated with autoimmune phenomena. To date, VL mimicking or exacerbating various autoimmune diseases have been described, including systemic lupus erythematosus (SLE), rheumatoid arthritis, and autoimmune hepatitis (AIH). Herein, we presented a patient with VL who had overlapping clinical features with SLE, AIH, as well as antimitochondrial antibody (AMA-M2) positive primary biliary cirrhosis.
Adult ; Autoantibodies/blood ; Bone Marrow/pathology ; Cytological Techniques ; Diagnosis, Differential ; Female ; Hepatitis, Autoimmune/complications/*pathology ; Histocytochemistry ; Humans ; Leishmaniasis, Visceral/complications/*diagnosis/*pathology ; Liver/pathology ; Liver Cirrhosis, Biliary/complications/*pathology ; Lupus Erythematosus, Systemic/complications/*pathology