Portal hypertension caused by partial nodular transformation of the liver

SUMMARY The course of the disease in, and the necropsy on, a 46-year-old woman with partial nodular transformation of the liver are described. This is, as far as is known, the fifth case to be reported. On the basis of results obtained from clinical tests partial nodular trans-formation of the liver was assumed. Seven months after the first episode of haematemesis and after numerous haemorrhages, the patient died. The morphological picture of the liver confirmed the tentative diagnosis. In spite of opinions to the contrary (Ingelfinger, 1967), the clinical picture of portal hypertension, can, by reason of the morphological findings, be clearly differentiated from hepatic cirrhosis and other nodular changes in the liver. Case Report A 46-year-old housewife had had epigastric complaints for several years and, during the few months before admission to hospital, addi-tionally noticed some loss of weight and appetite. There was no history of hepatitis, nor was there any question of alcohol abuse. In February 1968 the patient had a sudden haematemesis and was admitted to hospital. Radiological evidence of oesophageal varices was found. A liver specimen, obtained by percutaneous needle biopsy, showed slight damage to the parenchyma, accompanied by sparse necrotic areas, moderate activity of the parenchyma, periportal fibrosis, and central lobular sclerosis. In May 1968 the patient was admitted to this hospital for further diagnosis. The patient had a slightly jaundiced skin and sclerae and palmar erythema, but no spider naevi. The liver edge was 3 cm below the right-hand portal margin. The spleen was consid-erably enlarged and ascites was present