Idiopathic non-cirrhotic intrahepatic portal hypertension in the West: a re-evaluation in 28 patients

Incomplete septal cirrhosis: an enigmatic disease

Incomplete septal cirrhosis is a form of macronodular cirrhosis characterized by fine and incomplete septa, which delimit rudimentary regeneration nodules. Its etiopathogeny is uncertain and is associated with various diseases such as regenerative nodular hyperplasia, idiopathic portal hypertension, and partial non-cirrhotic nodular transformation, as well as with progression and regression of cirrhosis of any etiology. Few studies are available in the literature describing the clinical and biological characteristics of incomplete septal cirrhosis.

GOAL

The objective of the present descriptive study was to study this entity in the city of Salvador, Bahia, Brazil, and to compare the histopathological, biological and clinical data obtained with those reported in the specialized literature.

MATERIALS AND METHODS

We reviewed eight cases of incomplete septal cirrhois of varieties etiologies. Hepatitis C, autoimmune hepatitis, alcoholic liver disease and criptogenic liver disease were present in our cases. Fibrosis progression as well as cirrhosis regression could be identified in these patients.

CONCLUSIONS

We concluded that Incomplete septal cirrhosis is not a disease itself but it could be considered as a stage of progression and regression of liver fibrosis.

Association of idiopathic hepatic sinusoidal dilatation with the immunological features of the antiphospholipid syndrome

BACKGROUND

Isolated sinusoidal dilatation is an uncommon hepatic lesion and the cause is largely unknown.

OBJECTIVE

To investigate whether prothrombotic disorders or perisinusoidal cell changes could be involved in pure idiopathic hepatic sinusoidal dilatation (HSD).

METHODS

Evaluation for associated conditions, prothrombotic disorders, and studies of hepatic perisinusoidal cell activation in consecutive patients, seen between 1993 and 2002, with isolated sinusoidal dilatation unrelated to outflow block, sinusoidal infiltration, or hepatic granulomas.

RESULTS

Among 11 patients, associated conditions were prothrombotic disorders (n = 5) and oral contraceptive use (n = 3). Prothrombotic disorders were polycythemia vera (n = 1) and anticardiolipin antibodies combined with lupus anticoagulant (n = 4). No genetic thrombophilia factor was found. Of four patients with lupus anticoagulant, three had antinuclear factors and high serum levels of anticardiolipin antibodies at repeated testing. There was no evidence of intrahepatic or extrahepatic thrombosis in any of the patients. Sinusoidal dilatation was marked in six of 11 patients (54%), including two patients with antiphospholipid antibodies. Activated perisinusoidal cells were only found around markedly dilated sinusoids.

CONCLUSION

Idiopathic pure HSD is frequently associated with the immunological features of the antiphospholipid syndrome. Therefore, finding pure HSD in a liver biopsy specimen should prompt the search for antiphospholipid antibodies.

Nodular regenerative hyperplasia of the liver and coeliac disease: potential role of IgA anticardiolipin antibody

Nodular regenerative hyperplasia (NRH) of the liver is a rare disorder that is often associated with connective tissue disorders, haematological malignancy, or drugs, and is a cause of non-cirrhotic portal hypertension. We describe two cases of NRH in individuals with adult coeliac disease and IgA anticardiolipin antibodies. We discuss the potential impact of this observation on the understanding of the pathogenesis of NRH.