The aim of this paper is to provide guidelines for
the pathologist on the definition, nomenclature, and
classification of hepatic cirrhosis and related conditions.
Many systems of classification are in current
use in different parts of the world (Table 1). This
hinders comparisons of published data and the
accurate evaluation of relationships between cirrhosis
and liver cancer. Different words have been used
to describe essentially similar features; thus ' septal ',
'regular ', ' uniform ', ' micronodular ', and ' monolobular'
all refer to a particular morphological
pattern of cirrhosis which is widely recognized.
Conversely, a single word may be applied to a variety
of forms; for example, 'portal ' cirrhosis means one
with regular, small nodules to some, but is used by
others for any cirrhotic liver without further qualification.
Another weakness of some classifications is
that they are based on a mixture of pathogenesis,
morphology, and etiology (e.g. 'post-necrotic ',
' portal ', and ' biliary ' cirrhosis). There is, therefore,
a need for a logical and readily reproducible
system.
The diagnosis of cirrhosis is considered important
because it has serious clinical and prognostic implications
which are different from those of hepatic
fibrosis. Cirrhosis is held by most to be an irreversible
state, and instances of regression from established
cirrhosis to normal liver architecture are rare
and open to doubt. Fibrosis and chronic hepatitis are
both discussed separately at the end of the paper.
In the preparation of these guidelines, comments
and criticisms from a number of other pathologists
and hepatologists throughout the world have been
taken into account. An attempt has been made to
study a wide variety of material from different
geographical areas.