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A comparative histopathological study of hepatic venous outflow obstruction in veno-occlusive disease and Budd-Chiari's syndrome.

Forty-two cases of hepatic venous outflow obstruction with biopsied and autopsied specimens were studied. The morphological changes in the liver and the value of liver tissue in the diagnosis among the different subgroups of this conditions were evaluated. Seven cases in the group with veno-occlusive disease (VOD) showed prominent changes in the sublobular veins and terminal hepatic venules and were characterized by acute disruption of the vessel walls. Two cases showed thrombosis in which there were history of chemotherapy. In the group with Budd-Chiari's syndrome (BCS), in addition to the involvement of the large veins, thrombosis was observed in the small hepatic vein radicles in five out of six cases with myeloproliferative related disorders. Thrombosis was rarely present in cases associated with idiopathic and web lesions in BCS but frequent large vessel tumor thrombosis was noted in the group with malignant tumors. The hepatic parenchymal changes in the VOD group and the tumor related cases in BCS group were acute perivenular congestion, hemorrhage and coagulative necrosis, whereas the histological changes in other subgroups of BCS were perivenular scarring, dilatation of the sinusoids and rarely, reversed lobulation. Subtle differences were noted in the vascular system and the liver parenchyma between each subgroup. If good clinical information is available, it is possible to differentiate the various etiologies in hepatic venous outflow obstruction in the liver by morphology.