Abstract
Background. An objective morphological conclusion about the presence of lesions in the liver can be given only by a qualified clinical morphologist, who operates using the existing international criteria for evaluation of the most typical changes in the liver, including characteristics of necrosis. The aim is to present the morphological characteristics of liver necroses according to the data of intravital liver biopsy in chronic diffuse lesions of various etiologies.Material and methods. Liver biopsy was obtained by performing aspiration liver biopsy in patients with chronic viral, alcoholic, toxic and metabolic liver lesions, whose written informed consent had been obtained.We used the methods of light microscopy including semifine sections and those of electron microscopy.Results. The photomicrographs represent the most typical samples (types) of necroses – coagulation and colliquative, descriptions and images of the changes in the hepatocyte cell nucleus (karyopyknosis, karyorrhexis, karyolysis) and cytoplasm (coagulation and lysis of cytoplasmic proteins, their breakdown with detritus formation and cytolysis). Necroses characteristics corresponding to the international morphological classification are presented in detail. Depending on the area of necroses proliferation, their localization in the liver lobule and severity the following variants of hepatocyte necrosis are distinguished: monocellular; focal (spotted); stepped; zonal; acinar; bridged (port-portal, port-central, centro-central); submassive; massive. The main criteria for the semi-quantitative evaluation of necrosis used in clinical practice in different countries are presented.Conclusions. In vivo morphological diagnostics makes it possible to determine the stage of development, the nature (type) and preferential localization of necrosis, to assume its etiology, to predict the course and outcome of liver damage. An essential factor that increases the quality of diagnosis is the simultaneous morphological study of a single biopsy by light and electron microscopy.
Highlights
An objective morphological conclusion about the presence of lesions in the liver can be given only by a qualified clinical morphologist, who operates using the existing international criteria for evaluation of the most typical changes in the liver, including characteristics of necrosis.The aim is to present the morphological characteristics of liver necroses according to the data of intravital liver biopsy in chronic diffuse lesions of various etiologies
Для световой микроскопии полутонких срезов образцы биоптата печени пациентов размером 0,5×2 мм фиксировали методом двойной фиксации: вначале – по методике Sato Taizan [15]; затем образцы ткани в течение 1 часа дополнительно фиксировали в 1% осмиевом фиксаторе, приготовленном на 0,1 М фосфатном буфере Зёренсена рН 7,4
An essential factor that increases the quality of diagnosis is the simultaneous morphological study of a single biopsy by light and electron microscopy
Summary
Цель – представить морфологическую характеристику некрозов в печени по данным прижизненной биопсии печени при хронических диффузных поражениях различной этиологии. Отличием апоптоза от некроза является распад клетки на фрагменты (апоптозные тельца) при сохранении плазматической мембраны, изменение которой привлекает к себе звездчатые клетки, клетки Купффера, резидентные макрофаги печени, в которых ядерные фрагменты расщепляются лизосомальными ферментами, не выделяясь наружу и не вызывая воспалительной реакции в окружающей ткани [5, 6, 7]. При построении большинства активно применяемых в настоящее время клинических классификаций в диагностике хронических поражений печени разной этиологии (вирусной, алкогольной, токсической, метаболической и др.) для описания некроза используется оценка характера, локализации, степени выраженности и других особенностей процесса [8,9,10,11,12,13,14]. Цель исследования – представить морфологическую характеристику некрозов в печени по данным прижизненной биопсии печени при хронических диффузных поражениях разной этиологии. Журнал Гродненского государственного медицинского университета, Том 15(5), 2017 557
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