O mapeamento da unidade funcional hepática: Uma ferramenta para diagnóstico e pesquisa

Abstract

Introduction: Several theories have been proposed for the morphofunctional analysis of the liver. Objective: The purpose of this paper is to establish a standard and pratical procedure to understand the liver morphophysiology and hepatic alterations, based on the correlation of the predominant metabolism with the porto-central circulation pattern. Methods: This study presents a grid model of morphological study (GMMS), designed with the use of Microsoft® PowerPoint software. Furthermore, it demonstrates its application in histopathological diagnosis and interpretation of liver physiopathology. Results: The GMMS application in three clinicopathological cases allowed a more accurate analysis of liver lesions from several circulatory and metabolic areas of the liver lobe, which were defined in the grid accordingly. Moreover, it allowed a better understanding of the pathophysiology in each case and the correlation of histopathology diagnosis with clinical data. Discussion: The GMMS shows the importance of the metabolic zoning with the definition of a virtual interlobular septum. The GMMS application demonstrates the lobular asymmetry in the liver and its correspondence with different areas of the regular lobe, enabling a better definition of morphofunctional unit boundaries and its respective areas of metabolic predominance. Conclusion: The GMMS allows an integrated analysis of the liver by correlating its microanatomy with different circulatory and metabolic gradients, which provides a useful tool for histopathological diagnosis. The GMMS should be used in cases that do not involve abnormalities in the liver structure since its implementation depends on the relationship between the portal spaces and the centrilobular vein as reference points.