Smooth liver surface may conceal cirrhosis. Evidence for the late development of nodular surface of the cirrhotic liver.

A 22-year-old male student with HBs Ag + acute hepatic necrosis was admitted to our clinic for further examination. Since his liver function worsened, laparoscopy with direct vision hepatic biopsy was performed. Macroscopically, the surface of the liver did not show the characteristic nodular appearance, in contrast to histological alterations suggestive of liver cirrhosis. Eight months later, a second laparoscopic/bioptic examination was performed. The liver surface appeared nodular, while the histological picture was unchanged vis-a-vis the first examination. The discrepancy between the macroscopic findings observed at the first laparoscopy and those seen eight months later, would suggest that cirrhosis initially develops "inside" the liver and can only be detected histologically; the characteristic nodularity of the liver surface "emerges" subsequently.