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 Horea, 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
hematokylin-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,
cholangitis, 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 ciliary atresia, passive
congestion, fatty metamorphosis, clonorchiasis and granuBomatous 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 conmmon 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.
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