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Clinico‐pathological Study on Needle Biopsy in 97 Children with Liver Diseases

The findings by needle biopsy perfomed on 97 children with liver diseases in the department of pediatrics for approximately 7 years from 1965 to 1971 were classified by diseases, and the differences in the findings and the biopsy pictures were studied statistically. Needle biopy was performed by the one second method using Menghini’s improved needle. Of the cases studied the infantile hepatitis was the most, followed in the decreasing order by 18 cases of congenital biliary atresia, 8 of acute hepatitis, 7 of liver cirrhosis’ and 5 of the posthepatitic fibrosis. The total number of biopsies performed was 112 and the ages of the children ranged from 1 month to 9 years, the majority being infants. In this paper discussion will be made on congenital biliary atresia and infantile hepatitis, which were the greatest in number. (1) i) In biliary atresia changes in the liver cells such as giant cells, cloudy swelling and desposition of bile pigment were observed at a high frequency and the changes in the proliferation of pseudo-bile duct, bile thrombus and fibrosis being especially marked. Glisson’s capsule was infiltrated by the neutrophils, being observed in 90%; enlargement of the bile duct and fibrosis around the bile duct were each observed in 85%; hypertrophy of the hepatic artery wall in 70%) necrosis of the hepatic cells in 65%, increase of reticular fibers in 95%) and reaction of Kupffer cells in 85%. In infantile hepatitis giant cells, vacii) uolar degeneration, cloudy swelling, cellular infiltration and fibrosis were observed with a comparatively high rate. The cellular infiltration of Glisson’s capsule was somewhat strong compared to biliary atresia, and neutrophils and lymphocytes were observed at almost the same frequency and eosinophils were observed in approximately one half of the cases. Edema was in 86% and the mesenchymal cell reaction in 71%. However, hypertrophy of the hepatic artery wall was not observed in any cases. Irregularity in the size and polymorphism of the hepatic cells were observed in 90% and increase of reticular fibers, the infiltration of the sinusoid and the central vein were each observed in over 70% of the cases. The rate of appearance of giant cells was 90% in biliary atresia and 74% in infantile hepatitis, being somewhat higher in atresia. In studing the frequency of the appearance of giant cells by month, there was no distinct difference due to the time of cases in the grade of appearance of giant cells in hepatitis than in atresia. In this connection, viewed as a whole, by liver biopsy giant cells were observed in 58%. i) The correlation value between the total serum bilirubin value and cloudy swelling and that between bilirubin and cellular infiltration were -0.162 and -0.357, respectively, being not significant, and the correlation value between liver enlargement and cellular infiltration and that between liver enlargement and fibrosis were 0.090 and iii)