Electron Microscopic Studies in Biliary Atresia: II. Hepatocellular Alterations

WHILE some hepatocellular degenerative changes and distortion of hepatic cell plates occur in livers of adults with extrahepatic obstruction,¹ there are differing views on the status of the hepatic parenchyma in congenital atresia. Moore² described normal-appearing hepatocytes in all but one of 19 patients with congenital biliary atresia. However, Myers³ observed hepatocellular degeneration in all of his cases. Kasai et al⁴ reported that over half of the livers of patients with congenital atresia exhibited distortion of hepatic cell plates and degenerative changes in the hepatocytes. In 85% of the patients studied by Stowens,⁵ the hepatocytes themselves showed no abnormalities although their alignment was poor and the lobular architecture was distorted. In the latter stages of the disease, cholestasis and fatty metamorphosis appeared. The remaining 15% of the liver exhibited many giant cells. In those cases where it was possible to follow the disappearance of the multinucleated balloon cells