LIVER - Cirrhosis and haemochromatosis

A portion of liver cut to display both the capsular area and the cut surface. The cut surface shows many nodules separated by paler tissue; the nodules are fairly even in size, although an occasional larger nodule can be seen; this is probably apparent on the capsular surface than on the cut surface. The liver has a tan colour, characteristic of haemochromatosis; on the face of the cut surface a disc of tissue can be seen embedded in the liver; this is artefact; an attempt was made to stain a portion of the liver for iron, and to reinsert that in the specimen, but the iron-stain has diffused out.
This man had Blalock operation for Tetralogy of Fallot in 1954, with final correction of the lesion in 1971. In 1973 he was found to have a chronic hepatitis, which was not biopsied because of a prolonged prothrombin time. Serum iron and transferrin levels were at that time normal. The transaminases were slightly elevated. His skin became increasingly pigmented and early in 1977 he developed gross heart failure; he died towards the end of the year. At autopsy his liver was found to weigh 1350 g. and to show a fine cirrhosis, together with iron overload. He was found to have oesophageal varices and an enlarged heart at 620 g. The coronary arteries showed no atheroma, but the cusps of the pulmonary valve were thickened. Iron was demonstrated in the spleen, kidney, adrenal, pituitary, pancreas, thyroid and myocardium. There is no known family history of haemochromatosis.