ELECTRON MICROSCOPY OF LIVER LESIONS IN PRIMARY BILIARY CIRRHOSIS

An 80 μm bile duct with typical features of chronic non-suppurative destructive cholangitis was examined by electron microscopy. Many inflammatory cells, including lymphocytes, macrophages and plasma cells infiltrated among epithelial cells of the bile duct. Epithelial cells were compressed and deformed by infiltrating lymphocytes. These lymphocytes were in contact with epithelial cells at small points or large areas. The intercellular distance was about 10 or 20 nm at the contact areas. The mode of contact and intercellular distance coincided with the results of in vitro experiments on lymphocyte cytotoyicity against target cells. Some epithelial cells in contact with lymphocytes showed degenerative changes. Necrotic changes were observed in bile duct epithelial cells undergoing emperipolesis. The invading lymphocyte in the epithelial cell had osmiophilic substances on the surface. These sites of emperipolesis seem to be the areas of lymphocyte cytotoxicity against epithelial cells.     

ELECTRON MICROSCOPY OF GRANULOMATOUS LESIONS OF THE LIVER IN PRIMARY BILIARY CIRRHOSIS

Three granulomas in the portal tract and 9 bile ducts with typical features of chronic non-suppurative destructive cholangitis (CNSDC) associated with dispersed epithelioid.cells were examined by electron microscopy in 10 patients with primary biliary cirrhosis (PBC). Vesicular epithelioid cells, which contained numerous single-membrane bound vesicles, predominated in the granulomas. On the other hand, immature epithelioid cells and activated macrophages were more often observed near epithelial cells of the bile ducts with CNSDC than in the granulomas. These macrophages seemed to be activated by epithelial cells of the bile ducts and develop into epithelioid cells. Honeycomb-like membranous labyrinths containing electron dense substances were frequently observed in epithelioid cells and were likely a special form of phagosome. The substances in the labyrinths seemed to be derived from organellae of necrotic cells and extracellular interstitial tissues. Subplas-malemmal linear densities (SPLD) were observed at the cytoplasmic boundary and at intracytoplasmic membranous labyrinth. The roles of SPLD were discussed. ACTA PATHOL. JPN. 35 : 1309–1318, 1985.     

FLORID DUCT LESIONS AND EXTENSIVE BILE DUCT LOSS OF THE INTRAHEPATIC BILIARY TREE IN CHRONIC LIVER DISEASES OTHER THAN PRIMARY BILIARY CIRRHOSIS

Intrahepatic biliary tree with either florid duct lesions or a moderate to severe degree of the duct loss in four livers with chronic hepatic diseases other than primary biliary cirrhosis were studied with histometric and serial section observations. Florid duct lesions, distributed segmentally in the liver, were found in one case with incomplete septal cirrhosis and one case with idiopathic portal hypertension. The florid duct lesions including marked plasma cell infiltration and occasional periductal granulomas, were not associated with any bile duct loss in the two cases. The duct lesions were reversible in one case during a long clinical course. On the other hand, a moderate to severe bile duct loss with biliary epithelial degeneration and necrosis was associated with no or little periductal inflammatory cell infiltration in one other case with chronic intrahepatic cholestasis, probably drug-induced, and in one case with idiopathic portal hypertension. Although florid duct lesions and bile duct loss were important diagnostic features of primary biliary cirrhosis, one of them was observed to develop independently in severely diseased livers, not consistent with a diagnosis of primary biliary cirrhosis, sclerosing cholangitis or intrahepatic bile duct paucity syndrome.     

MORPHOLOGICAL STUDIES OF THE SPLEEN IN IDIOPATHIC PORTAL HYPERTENSION (SO-CALLED BANTI'S SYNDROME WITHOUT LIVER CIRRHOSIS) USING LIGHT MICROSCOPY, SCANNING ELECTRON MICROSCOPY AND HISTOMETRY

Morphological changes in the spleens of patients with idiopathic portal hypertension (IPH) were studied and compared with the normal spleen. The study used (1) light microscopy with histometry, (2) scanning electron microscopy (SEM) of the splenic tissue with histometry and (3) SEM of the spleen vascular replica. Histometrical studies by light microscopy showed that the volume of red pulp of IPH was increased in a unit area and to a total of 12 times the normal in the whole spleen. The white pulp was scanty of lymphocytes and decreased in a unit area but it was increased in the whole spleen. SEM of the white pulp of IPH demonstrated many channels formed by reticulum cells and running parallel with each other along the central artery. This finding presumably corresponds to periarterial fibrosis in light microscopy. SEM histometry demonstrated that the venous sinuses of IPH were small but increased in number and occupied the same percentage area in a unit red pulp area as in the normal spleen. The Billroth cord of IPH was narrowed and occupied by thickened reticulum cells, which may cause increased pooling and destruction of blood cells in the enlarged spleen (hypersplenism). SEM of the tissue and vascular replica demonstrated open arterial termination in the Billroth cord in the spleen of IPH as well as in the normal spleen. Venous sinuses in the replica of IPH ran parallel with each other forming bundles with fewer intercommunications than normal.     

ANATOMICAL LESIONS BEING RESPONSIBLE FOR DEVELOPMENT OF PORTAL HYPERTENSION IN CARBON TETRACHLORIDE-INDUCED RAT LIVER CIRRHOSIS

The hemodynamics of carbon tetrachloride-Induced rat liver cirrhosis were examined by means of the perfusion experiment and the anatomical lesions being responsible for the development of portal hypertension were evaluated. The portal blood flow of isolated rat liver was 3.07±0.53 ml/g/min. in intact rats, 1.94±0.24ml/g/min. In fibrosis rats and 1.75±0.23 ml/g/min. in cirrhosis rats under the condition of perfusion pressure 13.5 cmH₂O and of Ht 36%. The flbrotlc liver as well as cirrhotic liver showed marked elevation of hepatic vascular resistance, and more than 20 cmH₂O perfusion pressures were necessary for the fibrotlc liver as well as the cirrhotic liver to hold the normal level of hepatic blood flow. There was no perceptible stenosis or distortion of the Intrahepatic portal tree and of the hepatic venous tree, but there was marked constriction of the sinusoid resulting from enlargement of the hepatic cell in the fibrotlc liver as well as in the cirrhotic liver. The Intimate correlation between the hepatic blood flow reduction and the extent of sinusoidal constriction suggested that vascular resistance of cirrhotic liver was located In the sinusoidal bed.     

PATHOLOGY OF LIVER CIRRHOSIS IN EXPERIMENTAL SCHISTOSOMIASIS JAPONICA

Rabbits were experimentally infected with Scbistosoma japonicum to observe morphological alterations of the liver to the 60th week of infection in chronological sequence. In the present report, the developing process of liver cirrhosis due to Schistosoma japonicum was elucidated together with the repairing process occurring after its cirrhotic state. It is concluded that the experimental liver cirrhosis due to Schistosoma japonicum is repairable. Consequently, in the persistence and progress of a cirrhotic state in the liver, repeated infections appear to play an important role.     

INCREASED ACIDOPHILS OF THE HYPOPHYSIS IN LIVER CIRRHOSIS

The percentage of cell number of 3 types of male anterior pituitary cells was counted in autopsy cases with liver cirrhosis and cases that died of other conditions. These cases were then compared. In liver cirrhosis, acidophils (somatotrophs and mammotrophs) showed a tendency to increase in cell percentages. Immunocytochem-istry also revealed the increase in the number of somatotrophs and mammotrophs in liver cirrhosis. Comparison of protein sythesis in cirrhotic liver and in healthy liver, in vitro, revealed that in the cirrhotic liver tissue protein synthesis was markedly depressed and GH for protein synthesis became more necessary than in a non-cirrhot-ic state. The disturbed protein synthesis and hypoproteinemia were suggested as causative factors of increased acidophils of the anterior lobe of the hypophysis.     

EXPRESSION OF β2-MICROGLOBULIN ON INTERLOBULAR BILE DUCTS IN PRIMARY BILIARY CIRRHOSIS AND OTHER HEPATOBILIARY DISEASES

Expression of β-microglobulin, a reliable marker of HLA Glass I, on the interlobular bile ducts (bile ducts) was surveyed using an immunoperoxidase method in paraffin sections of specimens from patients with a variety of hepatobiliary diseases. Normal bile ducts showed negativity or weak cytoplasmic positivity in normal as well as diseased livers. On the other hand, abnormal bile ducts showing degenerative or proliferative changes in primary biliary cirrhosis and graft-versus-host disease revealed enhanced expression of this protein, suggesting that these damaged bile ducts might be more susceptible to T cell-mediated immune attack in these immunologic diseases. However, enhanced expression of this protein was also similarly found on abnormal bile ducts in several nonimmunologic biliary diseases Including extrahepatic biliary obstruction. Enhanced expression of this protein on the interlobular bile ducts may therefore be an epiphenomenon secondary to different primary pathologic events in the biliary tree, such as immunologic and nonimmunologic processes. ACTA PATHOL JPN 38 : 853∼860, 1988.     

AFP,CA19—9联检在原发性肝癌和肝硬化鉴别诊断中的临床意义

为提高原发性肝癌的诊断率和与肝硬化，其他慢性肝病的鉴别诊断，本文采用放射免疫分析法和免疫放射分析法。对５０例健康体检者、４８例原发性肝癌、３９例肝硬化，３６例其他一肝病患者，分别检验其血清中甲胎蛋白，糖类抗原１９－９肿瘤标志物的含量，结果进行比较。     

HEPATIC MICROCIRCULATION OF LIVER CIRRHOSIS STUDIED BY CORROSION CAST/SCANNING ELECTRON MICROSCOPE EXAMINATION

Changes of hepatic microcirculations in 22 autopsy cases of liver cirrhosis were analyzed by corrosion cast/scanning electron microscope (SEM) examination. By this method, the site of arterioportal (A-P) communication in liver cirrhosis was clearly demonstrated between proliferated portal venules and arterial capillaries. The communications were observed at the same site as in the normal liver and were not at larger arterial and portal vein branches. The findings indicate that the increase of A-P communication in liver cirrhosis may be called "capillary shunting". On the basis of the findings, it was postulated that the A-P shunt could not assist in the development of portal hypertension by the transmission of high arterial pressure to the portal vein but could only compensate for decreased portal flow and/or elevate the oxygen concentration in the sinusoids to improve the hypoxic state of the liver parenchyma. It was also demonstrated that the arterial capillarization of the interstitial septa in micronodular wide septal cirrhosis was more prominent than that in macronodular thin septal cirrhosis. A grade of portal vein reduction and compensatory arterialization in a fibrous septum have been regarded as an index to estimate the advancement of liver cirrhosis. Therefere, if alcoholic micronodular cirrhosis could change into macronodular, the process should have occurred at least before the establishment of micronodular wide septal cirrhosis.     

家兔空肠淋巴管铸型的扫描电镜观察

为了探究空肠各层淋巴管的三维结构，将Ｍｅｒｃｏｘ注入家兔空肠壁内，制成淋巴管铸型后，在扫描电镜下观察。同时做半薄切片，以配合观察铸型标本。在空肠的粘膜层、粘膜下层、肌层等都存有毛细淋巴管、淋巴管。在小肠绒毛内可见到中央乳糜管，其三维结构在铸型标本上显示非常清楚；该管注入粘膜层和粘膜下层的毛细淋巴管网，从网发出淋巴管穿肌层，入浆膜层，离开空肠。还可见到淋巴管铸型呈串珠状外观；铸型表面存有双凹切迹，此处相当于瓣膜的部位。铸型表面还呈现出淋巴管内皮细胞核的压迹     

家兔甲状腺内淋巴管铸型扫描电镜观察

用自行研制的水溶性淋巴管铸型剂（合成树脂三元共聚体的乳状溶液，共聚体含量占５０％），作器官实质注射，得到完整的兔甲状腺淋巴管铸型。甲状腺内淋巴管比相应的血管粗大，形状不规则，最显著的特点是许多淋巴管呈囊状膨大，且多位于小叶之间，称淋巴小囊，其大小与形状变化较大。这些淋巴小囊与其他淋巴管相互连接，构成三维的淋巴管系统，淋巴管铸型中呈盲端的淋巴管及一些淋巴小囊属于起始淋巴管（ｉｎｉｔｉａｌ ｌｙｍｐｈ     

MORPHOLOGICAL STUDIES OF THE SPLEEN IN SPLENOMEGALIC LIVER CIRRHOSIS COMPARING WITH THE SPLEEN IN IDIOPATHIC PORTAL HYPERTENSION (SO-CALLEDBANTI'S SYNDROME WITHOUT LIVER CIRRHOSIS)

Morphological changes of the spleen in splenomegalic liver cirrhosis (SLG) were studied. Comparisons with the normal spleen and the spleen of idiopathic portal hypertension (IPH) were made by (1) light microscopy with histometry, (2) scanning electron microscopy (SEM) with histometry, and (3) SEM of the spleen vascular replica. Hlstometrical studies by light microscopy showed that in both SLG and IPH, the white pulp volume was decreased in random units of splenic tissue but increased in the whole spleen, whereas the red pulp volume was increased both in random units of splenic tissue and in the whole spleen. The increase in the total volume of the white pulp was less marked in SLG than in IPH. SEM histometry demonstrated in the red pulp an increase in small venous sinuses and narrowing of the Billroth cord in SLG and IPH. Narrowing of the Billroth cord was more marked in SLG than in IPH. SEM of the white pulp showed channels formed by reticulum cells around the central artery in SLC and IPH. The channels are thought to correspond to so-called "follikulare Fibroadenie" or periarterial fibrosis. The spleen vascular replica demonstrated open arterial termination into the tissue spaces in the Billroth cord in SLG, IPH and the normal. Venous sinuses were arranged in bundles in SLC and IPH.     

六种血清肿瘤标志物检测原发性肝癌的结果评价

利用放射免疫分析（ＲＩＡ）方法，对７２例健康人，４８例原发性肝癌病人（ＨＣＣ）及４０例肝硬化病人血清，分别检测了甲胎蛋白分泌型免疫球蛋白Ａ，β２微球蛋白，酸性铁蛋白，铜蓝蛋白和免疫球蛋白Ｅ等六种肿瘤标志物，结果表明，原发性肝癌病人，血清各种瘤标志物含量均显著增高（与对照组比较呈显著性差别，Ｐ〈０．０１），部分项目与肝硬化一比较显著性差异，而它们单项目的阳性率分别为７２．９％，７５％，７７．１％，８     

人鼻粘膜微血管管壁的扫描电镜观察

用胰蛋白酶消化-盐酸水解结缔组织法处理成人下鼻甲粘膜标本,然后在扫描电镜下观察了鼻粘膜微血管的管壁结构.毛细血管前微动脉的管壁为分枝平滑肌细胞;在毛细血管前微动脉的末端观察到毛细血管前括约肌;肌性微静脉的中膜由几层环形排列的平滑肌细胞构成.本文还讨论了粘膜微血管管壁结构的机能意义.     

ELECTRON MICROSCOPY OF INTRADUCTAL PAPILLOMA OF THE BREAST

Intaductal papillomas, papillary carcinomas, and normal mammary large ducts were studied by electron microscopy. The intraductal papillomas were divided into two subtypes: fibrous and glandular. Comparative ultrastructural analysis of these two subtypes revealed definitive differences in the nucleus, chromatin, and presence of myoepithelial cells. An irregularly shaped nucleus, aggregated heterochromatin, and prominent myoepithelial cells were the conspicuous features of the fibrous type which appeared to be almost absent in the glandular type. Moreover, the fibrous type possessed intact basal laminae, various differentiations of the cell surface, desmosomes, terminal bar, intrastromal projections of crab-finger-like appearance of the myoepithelial cells, and a two cell layer arrangement of epithelial cells. In these features, the ultrastructural appearance of the fibrous type closely resembled that of the cells of the normal mammary large duct. The glandular type, on the other hand, more or less lacked myoepithelial cells, well-developed organelles and showed a euchromatin pattern in the nucleus. This type resembled the papillary carcinoma in its histological characters. An absence of basal laminae (infiltrating carcinoma only) and the presence of intracytoplasmic lumina were characteristic of papillary carcinomas, and these two features were not found in the intraductal papillomas.