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The term cholangitis or autoimmune cholangiopathy is applied to patients with a disease similar to primary biliary cirrhosis because of its clinical and histologic characteristics but in whom there is a repeated absence of antimitochondrial antibodies and, by the contrary, the presence of antinuclear antibodies. The initial description of these cases was carried out in 1987. Good response was observed to treatment with glucocorticoids in these first cases and others described later. A series of 13 female patients with features of autoimmune cholangitis diagnosed from 1987 to 1993 in the Hospital Clinic i Provincial from Barcelona, Spain, is retrospectively reviewed. These patients were compared with 13 patients with primary biliary cirrhosis diagnosed on the basis of clinical and histologic criteria and the presence of antimitochondrial antibodies. No relevant clinical or histological differences were observed between the two groups of patients. Six patients with autoimmune cholangitis underwent treatment with glucocorticoids with unequal response, and in 5 cases ursodeoxycholic acid was administered with a slight analytical improvement being observed. According to these results and the current data of these patients, autoimmune cholangitis should be considered as a variety of primary biliary cirrhosis, the main characteristic of which would be the absence of antimitochondrial antibodies more than that of being a specific, independent disease.

Acute hepatic failure secondary to involvement of the liver by hematologic malignancies is a very uncommon condition, and usually has a fatal prognosis. We describe the case of a woman who developed acute hepatic failure due to infiltration by a non-Hodgkin's lymphoma 18 yr after the initial diagnosis of a nodular-type lymphocytic lymphoma, while she was apparently in remission. Early diagnosis was achieved through liver biopsy; therefore, rapid administration of chemotherapy allowed her complete recovery. Hepatic biopsy may provide a diagnosis in patients in whom the etiology of liver failure is unknown, thus establishing the possible need for specific treatment.

Multiple bile-duct hamartomas are usually diagnosed at autopsy as an incidental finding. We report a case of a 50-yr-old male in whom multiple bile-duct hamartomas were suspected in an abdominal ultrasonography and confirmed by an echo-guided needle liver biopsy. The ultrasonography disclosed multiple scattered hyperechoic lesions with a diameter of up to 1 cm, associated with some anechoic lesions of a larger size and a cystic appearance. Computed tomography demonstrated multiple hypodense lesions that were not modified by the administration of contrast. Bile-duct hamartomas should be included in the differential diagnosis of multiple focal hepatic lesions at ultrasonography or computed tomography.

The development of hepatocellular carcinoma is frequent in patients with hepatic cirrhosis of any etiology. Despite the suggestion that portosystemic shunt may increase the risk of developing this neoplasm there are scarce clinical evidence to confirm this suggestion. The present cohort study was aimed at analyzing the follow up data of 232 patients included in 3 prospective randomized controlled studies in which the efficacy of shunt procedures (group I: portocaval or splenorenal anastomosis) versus techniques other than shunt (group II: esophageal transection or variceal sclerosis) in the treatment of upper-6I bleeding secondary to rupture of esophageal-gastric varices were compared. After a mean follow up of 50 months, no differences were observed between the two groups in relation with the prevalence of hepatocellular carcinoma (group I: 17%; group II: 12%; relative risk: 1.41 [CI 95%: 0.72 - 2.75]; p = 0.41) or the actuarial probability of developing this neoplasm (group I: 2% at 2 years, 21% at 5 years; group II: 7% at 2 years, 14% at 5 years; p = 0.42). The results of this analysis suggest that the performance of portosystemic shunt does not increase the risk of developing hepatocellular carcinoma in patients with hepatic cirrhosis.