Histological progression of the hepatic lesions in idiopathic portal hypertension (Banti's disease)--observations from 25 autopsies.

Abstract

Pathomorphological changes in the liver were studied in 25 Japanese autopsy cases of idiopathic portal hypertension (IPH), and the cause of histological progression of the hepatic lesion was discussed. The morphological changes in the IPH livers differed markedly from case to case, probably because of the different stages and/or different degrees of severity of the lesion. Most of the patient who had died of hepatic failure were elderly or had an advanced stage of the disease. The livers from these patients were usually atrophied. Parenchymal atrophy of the IPH livers is caused by an insufficiency of the portal blood supply, which is accelerated by progression of phlebosclerotic changes, secondary thrombi of the portal vein branches, and a decrease in the intrahepatic collateral vasculature. Although it is possible that aging and a prolonged duration of the clinical course are contributory factors in the progression of portal lesions, the pathogenesis of portal phlebosclerosis cannot be explained by passive congestion, alone. In the IPH liver, parenchymal atrophy and regeneration seem to exist together. It therefore appears that failure of compensatory parenchymal regeneration due to insufficient blood supply is a major factor in liver atrophy and deterioration of liver function.