CLINICAL MORPHOLOGY OF THE LIVER: FIBROSIS
Abstract
Background. The diagnostic capabilities for verification of liver fibrosis vary from blood biomarkers to genomics, however, the morphological method of investigation in the hands of an experienced specialist is decisive.
The objective of the study is to present the morphological characteristics of different stages of liver fibrosis.
Materials and methods. To diagnose different stages of liver fibrosis we used a complex method of morphological diagnostics based on the study of the biopsy specimen in the same patient simultaneously by several methods: classical light microscopy supplemented with original techniques for visualization of ultrathin sections and electron microscopy.
Results. The complex method of morphological diagnosis of liver fibrosis made it possible to diagnose the earliest stages of fibrosis associated with the activation of perisinusoidal lipocytes (stellate cells) located in perisinusoidal space and in close contact with hepatocytes and other cells. Different activity and stages of transformation of stellate cells into myofibroblates were demonstrated. The used techniques allowed us to present in the photographs different stages and types of fibrosis in the liver as well as to describe their morphological features.
Morphological characteristics of stage IV fibrosis corresponding to the development of liver cirrhosis are presented in the paper, the main signs of various variants of liver cirrhosis (incomplete septal, small-node, coarse-nodular, mixed) are described. The final section of the article presents the results of an evaluation of the effectiveness of bacterial lipopolysaccharides in the treatment of liver fibrosis, which have shown positive effects in reducing the rate of progression of liver fibrosis in patients with relapse of hepatitis C after unsuccessful interferon therapy.
Conclusion. At the present stage of development of hepatology, it is required to develop more advanced criteria for assessing the stages of liver fibrosis in clinical practice. A complex of histological and morphological indices, estimated by light microscopy of semithin sections and electron microscopy simultaneously in one patient, should be included in the classification system of assessing liver fibrosis. It is necessary to develop morphological criteria for the early stages of stellate cells activation, their differention, evaluation of the synthesis of extracellular matrix proteins, as well as for other stages, when the compensatory abilities of the liver itself are not exhausted.
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