[Clinical significance and histological classification of atrophy/hypertrophy complexes of the liver].

Biliary, portal, biliary/portal and hepatovenous obstruction have been recognized as the etiological factors leading to the atrophy/hypertrophy complex (AHC) of the liver. From 1987 to 1990 30 patients were evaluated in our department with documented significant AHC of the liver. The evaluation of these patients was performed at an interdisciplinary meeting of surgeons, gastroenterologists, radiologists and hepatologists. All patients were studied in regard to clinical, radiological and gastroenterological investigations, intraoperative findings and histology. We present the diagnostic pathway, which included ultrasound in 29 patients as the first diagnostic step and 26 patients in whom computed tomography was added. In 21 patients hepato-iodide scintigraphy was performed, in 14 patients ERCP and angiography, and in 8 patients PTC. Etiologically we found in 12 patients a post-cholecystectomy stricture (PCS) in 12 patients, a tumour obstruction in 9 patients, different etiologies (Echinococcus, Budd-Chiari syndrome, primary biliary cirrhosis [PBC], Mirizzi-syndrome) in 9 patients and an unclear etiology in 4 patients. On the basis of our study we present a new histological classification of the AHC. Severe histological changes were prognostically worse, even in benign diseases. Therapy planning is always dependent on a very precise diagnostic pathway and early recognition of AHC is essential for the planning of therapy and for the prognosis of the disease.