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Q J Med 2000; 93: 237-244
© 2000 Association of Physicians

Massive hepatic fibrosis in Gaucher's disease: clinico-pathological and radiological features

R.H. Lachmann1, D.G.D. Wight2, D.J. Lomas3, N.C. Fisher4, J.P. Schofield1, E. Elias4 and T.M. Cox1,

1 From the Departments of Medicine, 2 Histopathology and 3 Radiology, Addenbrooke's Hospital, Cambridge, and 4 Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, UK

Received 7 February 2000 Hepatomegaly is frequent in patients with type 1 Gaucher's disease and is associated with infiltration of the liver with pathological macrophages. Most patients suffer no significant clinical consequences, but a few develop portal hypertension which may progress to parenchymal liver failure. We describe four patients with Gaucher's disease who have developed portal hypertension. We have reviewed their clinical histories and all available histological and radiological material. All had severe Gaucher's disease with multi-organ involvement, and had undergone splenectomy in childhood. Histologically, this advanced liver disease was characterized by a picture of extreme and advanced confluent fibrosis occupying the central region of the liver. This massive fibrosis is associated with characteristic radiological appearances. The liver histology in these cases is highly unusual and virtually unknown in other conditions. Our studies indicate that without specific treatment the liver disease is progressive and rapidly fatal. However, institution of enzyme replacement therapy with imiglucerase may have beneficial effects even when the condition is far advanced.

Address correspondence to Professor T.M. Cox, Department of Medicine, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ. e-mail: jbg20{at}medschl.com.ac.uk


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