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Ductal plates in hepatic ductular reactions. Hypothesis and implications. III. Implications for liver pathology

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Abstract

This article discusses on the basis of the ductal plate hypothesis the implication of the concept for several liver abnormalities. The occurrence of ductal plates (DP) during liver growth in childhood would explain the paraportal and parenchymal localizations of von Meyenburg complexes in postnatally developed parts of the liver, and their higher incidence in adulthood versus childhood. It partly clarifies the lack of postnatal intrahepatic bile duct development in Alagille syndrome and the reduced number of portal tracts in this disease. Ductular reactions (DRs) in DP configuration are the predominant type of progenitor cell reaction in fulminant necro-inflammatory liver disease, when lack of sufficient parenchymal regeneration results in liver failure. The concept of dissecting DRs explains the micronodular pattern of advanced biliary and alcoholic cirrhosis. The concept explains the DP patterns of bile ducts in several cases of biliary atresia, with implications for diagnosis and prognosis. The hypothesis also has an impact on concepts about stem/progenitor cells and their niche.

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Acknowledgments

I thank Tania Roskams for helpful discussions and for providing the opportunity to keep in touch with progress in hepatopathology after my official retirement in 1996. Rita DeVos deserves my gratitude for help with illustrations.

Conflict of interest statement

I declare that I have no conflict of interest.

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  1. Department of Pathology, University Hospital K.U.Leuven, Campus St Rafael, Leuven, Belgium

    Valeer J. Desmet

  2. Department of Pathology, University Hospital St Rafael, Minderbroedersstraat 12, 3000, Leuven, Belgium

    Valeer J. Desmet

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Desmet, V.J. Ductal plates in hepatic ductular reactions. Hypothesis and implications. III. Implications for liver pathology. Virchows Arch 458, 271–279 (2011). https://doi.org/10.1007/s00428-011-1050-9

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