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Majethia et al., J Liver 2016, 5:1
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Journal of Liver DOI: 10.4172/2167-0889.1000193

ISSN: 2167-0889

Research Article Open Access

A Histo-Pathological Study of Liver in 118 Cases of Cirrhosis

Nikhil K Majethia*, Milind V Patil and AD Kalgutkar
Department of Pathology, Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, India

Abstract
The day has not arrived when predictive value of liver disease can be given like many laboratory tests. Autopsy
studies provide us with useful baseline data to start a step towards achieving good morphological accuracy. The
present study compromised of 118 cases of cirrhosis detected from the period January 2008 to December 2013.
3960 autopsies done during this period were scrutinized and 824 cases had liver pathology. Out of the 824 cases 118
had cirrhosis as the liver pathology, which makes incidence of cirrhosis at autopsy as 14.3% of all liver pathology,
which shows a decreasing incidence of cirrhosis which may be due decrease in autopsy rate over the years, the
reasons for the continuing decline are complex and include attitudes toward autopsies of hospital administrative
staff, medical staff, and family members and also because of increase in diagnosis by liver biopsy and introduction
of antifibrotic therapy.

Keywords: Cirrhosis; Liver; Wilson’s disease Data entry and statistical analysis
Introduction Data entry and analysis was done in Microsoft Office Excel 2007.
Master Chart was prepared in Excel.
Liver diseases and cirrhosis contribute to 23.59% of mortality in
world and ranks 27th as major cause of death in world and it is 2.74% Observation and Result
of all the causes of death in India [1] but still the exact preval1ence A total of 118 patients of cirrhosis were studied. The results
of cirrhosis is not known because the disease is often silent so 30% to obtained are analyzed as follows:
40% of cases are discovered at autopsy, indicating that in substantial
proportion of people, the disease goes undetected during life. There are Total number of autopsies done during Jan 2008 till December
various etiologies if cirrhosis and all these causes leave specific imprints 2013 - 3960
upon the liver so as to be identified histologically. Total number of autopsies with liver pathology - 824
Due to varied etiologies like alcohol which being the commonest, Total number of autopsies with cirrhosis as liver pathology - 118 
obesity diabetes, hepatitis B, C, all these don’t offer any frontline
diagnostic tool nor any treatment modalities to cirrhosis. Histology The year wise and sex distribution of cases of cirrhosis is shown
only remains a full proof diagnostic tool by which one can hope in the (Tables 1 and 2) above which shows a decreasing number of
autopsy and decreasing trend of incidence of cirrhosis on autopsy from
to identify various causes so quite right fully liver is called as “the
2008 to 2013 in men and a slight increase in incidence of cirrhosis in
custodian of milleu interior”, therefore autopsy study is a need of an
women. Maximum number of cases was in the age group of 31-40
hour. I our study we found 118 cases of cirrhosis out of 3960 autopsies
years (25.4%). The youngest case of cirrhosis was of 1 year of age and
which contributes to 14.3% as annual incidence most commonly
oldest case was of 90 years of age. 84 patients (71%) were males and
affecting between 30-50 years of male population. Various gross and 34 patients (29%) were females, when expressed in the ratio the male
microscopic findings were also studied. Such study would be helpful to to female ratio is 2:12. 97 patients (82%) were having positive history
identify the cause and decide the line of treatment. of alcoholism; remaining 21 patients (18%) were nonalcoholic. The
youngest case with history of alcoholism was 18 years and eldest was
Aims and Objectives
90 years (Table 3). The weight of liver between 1200-1300 grams was
1. To classify liver cirrhosis on morphological basis. 2. To taken as normal, which seen in 65 cases (55.1%). According to above
establish etiology of cirrhosis if possible. 3. To study the gross and criteria weight <1200 grams was considered as shrunken in 20 cases
microscopic changes in cirrhosis. 4. To study histopathology of liver (16.9%) and weight >1300 grams was considered enlarged in 33 cases
in cirrhosis. (28%). In the present study mean weight of liver was 1360grams.
Other gross finding like color was studied. Yellow was most common
Materials and Method
This was a descriptive cross sectional retrospective (2008-2011)
and prospective (2012-2013) study carried out at Lokmanya Tilak *Corresponding author: Dr. Majethia Nikhil Kantilal, Assistant Professor,
Memorial Municipal General Hospital which is a tertiary care Department of Pathology,TMMC& LTMGH, Sion, Mumbai, India, Tel: +09890352730;
E-mail: [email protected].
hospital in the Department of Pathology which is having Post mortem
Histopathology Subunit where daily autopsies are done and prompt Received December 23, 2015; Accepted February 03, 2016; Published February
11, 2016
histopathology reporting is done. All Cases diagnosed as cirrhosis by
gross and microscopic examination duly recorded in autopsy records, Citation: Majethia NK, Patil MV, Kalgutkar AD (2016) A Histo-Pathological Study
of Liver in 118 Cases of Cirrhosis. J Liver 5: 193 doi:10.4172/2167-0889.1000193
included in this study. Out of the total 824 Liver Pathology Cases
the 118 number of cases with diagnosis of cirrhosis were selected for Copyright: © 2016 Majethia NK, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
the study. All data were obtained from the autopsy history sheet and unrestricted use, distribution, and reproduction in any medium, provided the
autopsy records. original author and source are credited.

J Liver
ISSN: 2167-0889 JLR, an open access journal Volume 5 • Issue 1 • 1000193
Citation: Majethia NK, Patil MV, Kalgutkar AD (2016) A Histo-Pathological Study of Liver in 118 Cases of Cirrhosis. J Liver 5: 193 doi:10.4172/2167-
0889.1000193

Page 2 of 7

color (57.6%). 97 patients (83.2%) had alcohol associated cirrhosis, 2 93% (110) of cases showed fibrosis of which portal to portal, portal to
patients (1.6%) had viral associated cirrhosis like Hepatitis B, Hepatitis central and both were 8%, 38% and 50% respectively. 43 cases (36%)
C each. Three patients (2.4%) had Wilson’s disease, one patient each showed inflammatory infiltrate. Bile duct proliferation was seen in
of hemochromatosis secondary to thalassemia sickle cell anemia, 51.6% cases. Hepatocytes changes like ballooning (Figure 2), steatosis,
post necrotic cirrhosis, cirrhosis secondary to storage disorder and necrosis and cholestasis in 0.8%, 67% and 9.3% respectively. Of the 80
NASH.10 patients (8%) had cryptogenic cirrhosis (Table 4). Majority cases of steatosis most common type of steatosis was macro vesicular
of the patients (50.5%) consumed 100-200 ml/day, 20.6% consumed type in 83% cases. 2 cases (1.6%) showed hemosiderin deposition.
between 200-400 ml/day (Graphs 1 and 2). 36% of the alcoholics
2cases showed features of malignancy. 12 cases (10%) of cirrhosis
were consuming alcohol for duration 10-20 years. 24% alcoholics
showed associated TB granuloma. Out of 97 patients of alcohol induced
were consuming for a period more than 20 years. Mean duration of
alcohol consumption was 11 years in females and 18.4 years in males. cirrhosis, 48.4% showed micronodular cirrhosis, 29.8% showed mixed
Nodularity (Table 5) was the other gross finding seen. Out of which cirrhosis (Figure 3), 19.5% showed macro nodular cirrhosis, of these 43
micro nodularity was seen in 48 cases and macro nodularity was seen cases (44.3%) of micronodular cirrhosis 4 cases had features of alcohol
in 39 cases and remaining 31 cases showed mixed features. Out of 118 induced hepatitis ,and early cirrhosis. Three cases showed fatty change
cases of cirrhosis the most common microscopic finding (Table 6) was and necrosis. Two cases of alcohol induced cirrhosis had associated
loss of lobular architecture of liver (Figure 1) in 114 (96.6%) cases. findings of hepatocellular carcinoma.

Year Total no. of autopsy Autopsies with liver pathology Autopsy with cirrhosis Percentage of cirrhosis(%)
2008 1248 309 28 11.8
2009 1025 178 21 12.7
2010 456 79 10 21.1
2011 390 90 19 23.6
2012 414 89 21 23.6
2013 427 79 19 24.0
Total 3960 824 118 14.3
Table 1: Year wise presentation of cirrhosis at autopsy.

Number Alcohol Biliary/ Post

Study Viral Wilson’s Hemochromatosis Nash Cryptogenic Others
of Cases Induced Autoimmune Necrotic
Manjunath et al. KIMS Hospital [3] 50 80% 16%           4%  
Goncalves PL et al. [20] 262 40.50% 26.70%           10.60% 3.80%
Medha Y Raoet al., MS Ramaiah Medical
43 58.10% 18.60%         4.60% 18.60%  
College, Bangalore [21]
Nandakumar et al. [4] 46 65% 25%       5%   5%  
Terada et al. [22] 209 12.40% 80.30% 5.10% 0.40% 1.40%       0.40%
Present study 118 83.20% 1.60% 0.80% 2.40% 1.60% ### 0.80% 8% 0.80%
Table 2: Etiological comparison of cirrhosis with other studies.

Parameter Findings
Age (30-50 years) 49.1%
Sex (Male: Female) 84:34
History of alcoholism (Male: Female) 93:4
Mean gross weight of liver 1200-1300 grams
Colour of liver (yellow) 57.6%
Table 3: Parameters and findings.

Causes No. of Cases Percentage

Alcoholic Cirrhosis 97 83.2%
Viral- HBV 1 0.8%
HCV 1 0.8%
Biliary Cirrhosis 1 0.8%
Wilson’s Disease 3 2.4%
Hemochromaosis Secondary To
1 0.8%
Thalessemia
1 0.8%
Sickle anemia
NASH 1 0.8%
Post Necrotic 1 0.8%
Cryptogenic 10 8%
Storage Disorder 1 0.8%
Total 118 100%
Table 4: Causes in different cases.

J Liver
ISSN: 2167-0889 JLR, an open access journal Volume 5 • Issue 1 • 1000193
Citation: Majethia NK, Patil MV, Kalgutkar AD (2016) A Histo-Pathological Study of Liver in 118 Cases of Cirrhosis. J Liver 5: 193 doi:10.4172/2167-
0889.1000193

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30
23 24
25
20
15 14
15 13

10
5 3

0
occasional 0-5 5 to 10 10 to 5 15 to 20 >20
Graph 1: Period of Alcohol Consumption by alcoholic cases (In Years).

20

49 20

3 1 120
0-100 100-200 200-300 300-400 400-500 500-600 600-700 >700
Graph 2: Amount of Alcohol Consumed in alcoholic cases(ml/Day).

Etiologically Micronodular<0.3 cm Macronodular>0.3 cm Mixed

Alcohol induced cirrhosis (n=97) 47 21 29
Virus induced cirrhosis (n=2) 2
Wilson’s disease (n=3) 3
Biliary cirrhosis (n=1) 1
Hemochromatosis (n=2) 2
NASH (n=1) 1
Post necrotic (n=1) 1
Cryptogenic (n=10) 8 2
Storage disorder (n=1) 1
Table 5: Etiologically of micronodular and macronodular.

Discussion Age and sex distribution of cirrhosis

The day has not arrived when predictive value of liver disease Out 118 cases 48.1% cases were in the age group 31-50 years, and
can be given like many laboratory tests. Autopsy studies provide mean age of cirrhosis was 43.67 years. It is occurred a decade earlier
us with useful baseline data to start a step towards achieving good than the study by Bal et al. [2] in which 42.8% cases of cirrhosis were
morphological accuracy. The present study compromised of 118 cases in age group 41-50 years. It is also similar to study conducted by
of cirrhosis detected from the period January 2008 to December 2013. Manjunath et al. [3] were mean age was 48.6 years and most common
3960 autopsies done during this period were scrutinized and 824 cases age group affected was 40-70 years. Many other studies by Nandkumar
had liver pathology. Out of the 824 cases 118 had cirrhosis as the liver et al. [4] and Chakrabati et al. [5] also the most common age group
pathology, which makes incidence of cirrhosis at autopsy as 14.3% of all affected were 41-60 years. There was male preponderance seen in our
liver pathology, which shows a decreasing incidence of cirrhosis which study. The male to female ratio was 2:1. In study conducted by Bal et al.
may be due decrease in autopsy rate over the years, the reasons for the [2] there was only single female case of cirrhosis. Male predominance
continuing decline are complex and include attitudes toward autopsies was also seen in study by Manjunath et al. [3] were only 16% of cases
of hospital administrative staff, medical staff, and family members and were females. In other studies like also males were more affected.
also because of increase in diagnosis by liver biopsy and introduction of
Distribution of cases according to etiology of cirrhosis
antifibrotic therapy. The result shows a decreasing trend as evident by
the (Table 1) showing year and sex distribution of cirrhosis on autopsy. Though identification of cirrhosis at autopsy is easy on gross
The findings are comparable to study conducted by Bal et al. [2] in as defined by a working party for the World Health Organization
which the incidence of cirrhosis was 14%. (WHO) in 1978 as: “a diffuse process characterized by fibrosis and

J Liver
ISSN: 2167-0889 JLR, an open access journal Volume 5 • Issue 1 • 1000193
Citation: Majethia NK, Patil MV, Kalgutkar AD (2016) A Histo-Pathological Study of Liver in 118 Cases of Cirrhosis. J Liver 5: 193 doi:10.4172/2167-
0889.1000193

Page 4 of 7

No. of Cases with Percentage

Features
these Features (%)
Loss of architecture 114 96.6
Fibrosis
Incomplete fibrosis 3 2.5
Bridging fibrosis-Portal-portal 9 7.6
Portal –central 42 35.6
Both 56 47.5
Inflammatory infiltrate-portal triadities
Chronic-lymphocytic 39 33.1
Lymphoplasmacytic 3 2.5
Lymphoid aggregates 2 1.7
Bile duct proliferations 61 51.7
Hepatocytes Figure 3: Mixed Cirrhosis of liver.
Ballooning 1 0.8
Micro vesicular steatosis 11 9.3 the conversion of normal liver architecture into structurally abnormal
Macro vesicular steatosis 67 56.8 nodules, but etiologic characterisation may be difficult. The results of
Both 2 1.7 various causes illustrated earlier results identified alcoholic as the most
Necrosis 11 9.3 common cause.
Sub massive 1 0.8
Centrilobular 10 8.5 In a study conducted in Delhi it was found that that there is decline
Cholestasis 3 2.5 in prevalence of HBV infection as a cause of chronic liver disease in
Hemosiderin deposition 2 1.7
the past five years. In the present study decreased incidence of HBV
Sinusoidal congestion 61 51.7
associated chronic liver disease can be attributed to this. So according
Dilatation 3 2.5
to the above a mentioned result there is a need to create more awareness
Malignancy 2 1.7
among general population regarding adverse effect of alcohol
Metastasis -
consumption [3]. A single case of biliary cirrhosis (0.8%),in which
Tuberculosis- granuloma 12 10.2
we came across a case of biliary cirrhosis secondary to extra hepatic
biliary atresia in a 12 month old male, which was a operated case of
Table 6: No. of cases with different features. extra hepatic biliary atresia. The histopathology of the liver showed
cholestasis, portal fibrosis, and ductular proliferation, expansion of
the portal areas due to fibrosis nodular transformation is evident as a
prelude to the development of secondary biliary cirrhosis.
3 cases (2.4%) of cirrhosis were secondary to Wilson’s disease. The
average age of onset of Wilson’s disease is 11.5 years and die before
age of 30 years as quoted by Ronald F. Pfeiffer [6] in his article on
Wilson’s disease, there is progressive copper accumulation ultimately
compromising hepatic function, the hepatic storage capacity is also
eventually exceeded and unbound copper spills out of the liver and
is deposited in other organs and tissues like heart, kidney, pancreas,
brain etc. where it also provokes damage and dysfunction. In our
study the average age were 15 years which is earlier than the average
age for cirrhosis in rest of cases, the liver sections from cases of
Figure 1: Micronodular Cirrhosis of Liver showing pale yellow surface of Wilson’s showed ballooning and feathery degeneration of hepatocytes,
liver characterized by small, granular nodulations. Scarring is comparatively cholestasis, fibrous band showed lympho-plasmacytic infiltrate and
fine and uniform in distribution.
bile duct proliferation. Special stain for copper like Orcein showed
reddish brown cytoplasmic granules.
There were two cases (1.6%) of hemochromatosis secondary to
thalassemia and sickle cell anemia, on autopsy liver was shrunken
in size and it showed bridging fibrosis vague nodules and brown
pigment in hepatocytes more in periportal areas. The special stain
for hemosiderin, Prussian blue reaction was positive showed iron
deposition in periportal hepatocytes and bile duct epithelium, kupffer
cells absence of iron in septate which are seen in cases of secondary
hemochromatosis. In both the conditions cirrhosis was secondary
to hemochromatosis because of iron overload due to repeated blood
transfusions for haemolytic anaemia.
Other causes included a case of NASH, post necrotic cirrhosis, and
Figure 2: Macronodular cirrhosis of liver showing coarse irregular scars with
large heterogeneous nodulations. Bumpy appearance of external surface
fatty acid oxidation.
viewed in silhouette.
Obesity, diabetes, hyperlipidemia and female sex are important

J Liver
ISSN: 2167-0889 JLR, an open access journal Volume 5 • Issue 1 • 1000193
Citation: Majethia NK, Patil MV, Kalgutkar AD (2016) A Histo-Pathological Study of Liver in 118 Cases of Cirrhosis. J Liver 5: 193 doi:10.4172/2167-
0889.1000193

Page 5 of 7

risk factors for NASH as mentioned by K Das, in our study it was the average intake was 90-180g/day. The prospective study on 258
in a 65 years old female known diabetic and hypertensive, admitted alcohol abusing men showed that 22% of the patients consumed 100-
for acute coronary insufficiency. No liver function tests were done in 125g per day. 21% consumed more than 250 grams per day and only
this case. The liver showed extensive fatty change and fibrotic band 5% consumed 50-75g/day. Morgan and Sherlock [13] evaluated 100
extending between the portal tracts giving rise to ill formed nodules alcoholics the amount was greater than 100g/day.
which are common in almost all cases of cirrhosis but due to presence
of above history diagnosis of NASH was reached Nadkumar et al. [4]. Duration of alcohol consumption
Reported 5% of cirrhosis secondary to NASH. While the post necrotic 36% of the alcoholics were consuming alcohol for duration 10-
cirrhosis was seen in 0.8% patientin present study, reported 4.6% of 20 years. Our study correlates with that mean duration of alcohol
postnecrotic cirrhosis. The case storage disorder induced cirrhosis was consumption was 10-13 years. Morgan and Sherlock [13] in their study
of defect in fatty acid oxidation in a 3 year old male with complaints revealed that mean duration of alcohol intake was 20.4 years in men
of developmental delay, the MRI of this case showed fatty change and 16.8 years in women.
in neck muscles, ante-mortem liver biopsy showed diffuse macro
vesicular steatosis with mixed inflammatory infiltrates and portal to Morphological findings
portal bridging fibrosis, post mortem section from liver showed altered In an autopsy study gross examination is most important in
liver architecture with thin fibrous septa forming nodules infiltrated by diagnosis and classifying of cirrhosis according to Gall [14]. In the
mononuclear infiltrate and bile duct proliferation and macro vesicular present study mean weight of liver was 1360 grams suggesting that
steatosis. Enzyme levels of carnititne and other biochemical tests were not there was hepatomegaly, it was shrunken (<1200 grams) in 20 cases
done. Special stain of Glycogen like PAS and PAS with diastase is negative. (16.9%), enlarged in 33 cases (28%) and normal in 65 cases (55.1%). In
Cryptogenic cirrhosis contributed only 8% of total cases as series study conducted by Agrawal et al. [15] from PGIMER, 2014 the liver
of discoveries in the laboratory and a few clinical observations have was studied on similar criteria and was found that in majority of cases
helped to established the aetiology of cirrhosis in the vast majority of the liver (288 cases 74%) was also enlarged and 90 cases (23%) were
patients, and the diagnosis of cryptogenic cirrhosis is infrequent now shrunken while only in 12 cases it was normal in weight.
a days as shown, while it contributed 61.9% of cirrhosis in study by Nodularity: Among the systems of morphological categories
MacSween [7]. Histologically these cases showed thick fibrous bands currently in use, the division of cirrhosis into micronodular,
encircled hepatocytes nodules with pseudoacinar transformation. These macronodular (Figure 4) and mixed forms is preferred. It can be applied
hepatocytes showed not much fatty change and few showed cholestasis. macroscopically and microscopically 79. In present study liver on gross
This could be the end stage of many disorders like metabolic defects or examination showed micronodularity (<0.3cm) in 48 cases (40.6%)
infective etiology, thus was labelled as cryptogenic as no other history and micronodularity (>0.3cm) in 39 cases (33.0%). Mixed nodularity
and investigations were available to classify these cases. was seen in remaining 31cases (26.2%). Among the alcoholics, 48.4%
Alcoholism and sex predilection in cases of alcoholic cirrhosis showed micro nodular cirrhosis , 29.8% showed mixed cirrhosis, 19.5%
showed macro nodular cirrhosis, similar results were observed in study
As present study comprised of large number of cases of alcoholic done by Agrawal et al. [15] were micronodularity was in 49% and
cirrhosis the alcoholism history was obtained from autopsy records. macro nodularity was in 26% cases. Other etiological causes of cirrhosis
Studies show that the amount of alcohol consumed and the duration contributed quite less in number, type of cirrhosis is like biliary cirrhosis
of that consumption are closely associated with cirrhosis. 97 cases showed micronodularity (Figure 5), similar to study by Aishima et al.
were having history of alcoholism. Of those, 95% were male. Similar [16] in 2006, in which out of 26 cases of biliary cirrhosis 12 had micro
results were seen in study where 92% alcoholics were male and 8% were nodular cirrhosis. Macro nodular cirrhosis was seen in varied aetiology
female. In study by Gronbaek et al. [8] the alcoholic male contributed like secondary to virus (2 cases), hemochromatosis (2 cases), Wilson’s
to cirrhosis was 72%. Women are less likely to be suspected of alcohol disease (3 cases), post necrotic (1 case), storage disorder like defect in
abuse, even if they develop withdrawal symptoms in hospital. There fatty acid oxidation (1 case) and cryptogenic cirrhosis (8 cases). All
are several reasons like social stigma a woman is less likely to admit to
these cases macro nodularity was secondary to hepatic necrosis caused
alcohol abuse but at any given level of alcohol consumption, women
by either virus, iron over load, copper deposition, enzyme deficiency
have a higher likelihood of developing cirrhosis than men. This
leading to fatty acid accumulation. Other gross finding like color of
phenomenon is poorly understood, but several possible explanations
liver was observed. It serves as an indication of underlying pathology,
exits like levels of alcohol dehydrogenase may be lower in the stomachs
like yellow discoloration indicates fatty liver, greenish discolouration
of females than in males, which would result in a higher blood alcohol
indicates bile stasis. In cases of hemochromatosis liver is brown in
content for females than for males who consume equivalent amounts
color. In present study yellow was most common color (57.6%). Green
of alcohol according to Frezza et al. [9] Because damage to the liver is
colouration (bile stasis) was seen in 55 of cases. In study conducted by
a function of blood alcohol levels and exposure time, factors that lead
most common color observed was yellow in 31% cases and consistency
to higher blood alcohol concentrations could at least partially explain
was soft and on cut surface was greasy [2].
females’ higher risk for alcohol related cirrhosis. Another possible
explanation is that estrogen may increase the susceptibility of the liver Microscopic findings in cirrhosis
to alcohol related damage Ikejima et al. [10] and Colantoni et al. [11].
Similar to gross examination microscopic examination is an
Behavioural factors, including drinking patterns and diet, also may integral part of autopsy. The microscopic evaluation of cirrhosis is
contribute to females’ higher risk of cirrhosis. essential to identify the underlying aetiology and mechanism of fibrosis
leading to cirrhosis, as it is the end result of variety of liver pathology,
Quantity of alcohol consumed (1ml=0.789g)
criteria indicating cirrhosis in decreasing order are nodules surrounded
Majority of the patients 50.5% were consuming 100-200 ml/ by septate with or without portal and central canal, hepatic vein
day, Van Waes and Leiber [12] in their study of alcoholic patients tributaries in contact with fibrous septa (Figure 6), connective tissue

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Citation: Majethia NK, Patil MV, Kalgutkar AD (2016) A Histo-Pathological Study of Liver in 118 Cases of Cirrhosis. J Liver 5: 193 doi:10.4172/2167-
0889.1000193

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septa linking central with portal canals, irregularity of architecture. suggests nutritional cause (alcohol) in pathogenesis of cirrhosis as it
In present study microscopy of all cases revealed loss of architecture is a centrolobular process of collagen deposition. While in Agrawal et
in 96% cases prominently in cases of alcoholic cirrhosis , equivalent al. [15] study portoportal was seen in 58% and portocentral in 47%
results were seen in Spahr et al. [17] (n=163). cases. Large steatosis droplet is one of criteria in diagnosis of alcoholic
cirrhosis with Mallory Denk bodies, pericellular fibrosis, hypo cellular
Portal triaditis i.e. inflammatory infiltrate which is an indicator of
central or portal bridges. In present study steatosis was seen in 68%
underlying activity of regeneration and repair was seen in 37 % cases;
cases, equivalent results (63.8%) were seen in Spahr et al. [17]. Bile
similarly 46% cases in study by Agrawal et al. [15] showed this feature.
duct reaction/proliferations the marker of regeneration in liver, more
Depending on which type of fibrosis is prominent in initial stages it
prominent in case of biliary cirrhosis secondary to EHBA. It is seen in
is possible to know the underlying cause of cirrhosis. In post necrotic
61% cases in present study. The results varied in other studied were in
central vein to portal areas is seen with displaced, disarranged central
Spahr et al. [17] it was 37% and in Agrawal et al. [15] it was only 12%.
vein and portal tracts. Creeping fibrosis/bridging or fibrillar tongues
interconnect and cause both circumscription and segmentation of Necrosis was present in 9% of cases and Cholestasis which is also
hepatic lobules. In present study bridging fibrosis was seen in 107 cases, a feature of biliary cirrhosis, occurs because of bile duct destruction or
portal to portal was seen in 7.6% cases which is characteristic of biliary obstruction. In present study it was seen in 2.5% cases, in Agrawal et
cirrhosis, portal to central in 35% cases and both in 47% cases, which al. [15] study these parameters were also observed less namely 16% and
10% respectively.
Hemosiderin deposition in hepatocytes which simulates fibro-
genesis, most iron overload cirrhosis show little inflammation,
diagnosis is possible ante-mortem when iron deposition precedes
fibrosis, post-mortem hemosiderin deposition is also seen in alcoholic
cases. In present study hemosiderin deposition was seen in two cases
of hemochromatosis secondary to thalessemia and sickle cell anaemia.
Likewise it was seen in 15% cases of Agrawal et al. study [15].
The frequent association of hepatocellular carcinoma with
cirrhosis.In present study HCC was seen in 2 cases, both were of
alcoholic cirrhosis with macro nodularity. The study by Kew [18],
demonstrated HCC to be more in macro nodular cirrhosis and was
Figure 4: Macronodular cirrhosis in case of Hepatocellular carcinoma.
secondary to alcohol, Hepatitis B virus.
There has been a massive increase in alcoholism in India
contributing to an increase in chronic liver disease including cirrhosis.
This leads to an immunodeficient state and along with malnutrition
which is commonly present in such patients, may increase the risk
of tuberculosis.12 cases (10%) were associated with tuberculosis
granuloma, while no such findings were seen in Agrawal et al. [15] study.
While it has been emphasized by Lin et al. [19] that cirrhotic patients
have a greater risk of TB than non-cirrhotic patients, particularly those
with alcoholism and hepatitis C infection, while in their study of 2.32%
developed tuberculosis [19].

Conclusion
Cirrhosis is still a common liver pathology and alcohol was found
Figure 5: Enlarged liver with wrinkled capsule. Cut surface shows to be a common etiology. The amount and quantity of alcohol are
Miconodular Biliary Cirrhosis. directly related to cirrhosis. The classical microscopic feature was loss
of architecture, fibrosis and portal triadities. So a public awareness
need of an hour to avoid such dreadful disease which is completely
preventable by simple absentee from alcohol unlike other etiologies
which may require vaccination antiviral therapy, frequent iron levels,
enzyme levels and liver biopsy to monitor ongoing disease process.
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0889.1000193

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ISSN: 2167-0889 JLR, an open access journal Volume 5 • Issue 1 • 1000193