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Morphometric assessment of hepatic fibrosis
ANATOMICAL PATHOLOGY MORPHOMETRIC ASSESSMENT OF HEPATIC FIBROSIS P. de la M. Hall', M. A. Jenner, L. R. Jarvis. M. Ahern. Department of Pathology, Flinders Medical Centre and Department of Medicine, RepatriationGeneral Hospital, Adelaide, S.A. A microcomputer image analysis system was used to measure collagen in sinus red stained liver biopsies:- normal liver n 4 4 . mild pericellular fibrosis n-6, developing cirrhosis n=8. micronodular cirrhosis n=4. The amount of collagen in each biopsy was measured in optical density units. Compared with normal liver, optical density measurements were statistically significantly increased in the livers showing mild pericellular fibrosis (p <0.005) and in developing and established minonodular cirrhosis (p <0.0001).Serial liver biopsies (n=3) were obtained from a patient receiving methotrexate 15 - 25 mg/wk for psoriatic arihropathy for eight years, total dose >3 g; alcohol consumption up to to0 g h k . Computerized measurement of these biopsies confirmed the progression of hepatic fibrosis as seen by routine light microscopy. Conclusion: Cornputerised morphometry offers a rapid and sensitive method for assessment of hepatic fibrosis; this methodology is currently being applied to the evaluation of serial liver biopsies from patients on long-term methotrexate. Presenter: Dr Pauline Hall, Histopathology Dept, FMC.
IT0 CELLS, CIRRHOSIS AND CANCER FOLLOWING DEFENESTRATION OF THE LIVER SlNUSOlDAL EN DOTHELIU M e n t s of Patholo and Sur ery, Christchurch School of Medicine, Christchurch Rospital. C%ristchurch, New Zealand Chylomicron remnants transporting dietary cholesterol and retinyl ester, enter the s ace of Disse through the open fenestrae in the sinusoiLl endothelium where they are extracted from circulation b specific receptors on the hepatocytes. Defenestration o r the human liver endothelium following alcohol abuse has been su ested as a mechanism for alcoholic hyperlipoproteinaemia. 8 o t only do chylomicron remnants continue to circulate, but the liver may also become depleted of vitamin A. Vitamin A is normally stored in the liver in the perisinusoidal lto cell (also known as the fat storin cell or lipocyte) which resides in the space of Disse. Ito celfs depleted of vitamin A transform into fibroblasts. In sclerosis around the hepatic venule, Ito cells increase in number, leadin to an increased matrix with basement membrane and coiagen under the sinusoidal endothelium and within the space of Disse. This stimulation of Ito cells may be triggered by a decrease in their vitamin A content, since the catabolism of chylomicron remnants may be hindered by the defenestration of the sinusoidal endothelium. Retinol is also known to influence the differentiation of epithelial cells; its lack may be related to carcinogenesis. We are currently examining the dimethyl nitrosamine fed rat as a model of cirrhosis and liver malignancy. This animal model, like the human alcoholic, shows early endothelial defenestration. Presenter: Assoc Prof Robin Fraser, Pathology Dept, CSM
Jli Keeling, l!oyal Hospital for Sick Childrerl, Edinburgh. Lxamination of the fetus fron pregnancies terminated for fetal anonaly should be done with great care. This should include a photographic and radiographic record as well as detailed external visceral description. Tissue should be retained for chrortiosor?e culture and 3:;A studies. Every effort s h o u l d be made t o confirm the diagnosis for which termination of pregnancy was undertaken. :onparison of scan diagnosis and pathological findings in 212 fetuses confirned the diagnosis in 117 and confirmed the major scan diagnoses but added useful inforrnation in a further 78 cases. In 17 fetuses, the ultrasound diagnosis was not upheld but another major anomaly was present in 16 and serious defornities in the final case. Although prenatal ultrasound examination for fetal anomaly is accurate in respect of major malformations, it lacks t h e specificity required for accurate parental counselling after delivery. Detailed pathological examination makes a major contribution to patient management and s h o u l d be undertaken i n every case.
P. b e t h r a i t e * , L. holloway, L. dories, b. Lelahunt, Lepartcent of Patholocry, b ' e l l i n g t o n School of F-ledicine (r L e p a r t r e n t o f k e s p i r a t o r y heoicine, k e l l i n g t o n h o s p i t a l , Wellington, New Zealand. hine cases o f d i f f u s e malignant m s o t h e l i o m a of t h e p l e u r a and peritoneum presented w i t h i n an e i g h t month p e r i o d t o our i n s t i t u t i o n . 'Ihe c l i n i c a l , a i a g n o s t i c and p a t h o l o c i c a l f e a t u r e s o f these cases were reviewed. In a d d i t i o n , a c o c p l e t e s o c i a l and occupational h i s t o r y was k obtained t r o r t h e p a t i e n t s o r t h e i r next-of-kin. nurber of i n t e r e s t i n o p o i n t s emerge t r o r t h i s case s e r i e s i n c l u d i n g t h e low y i e l d o f diagnosis u s i n g c y t o l o o i c a l e x a n i n a t i o n o f serous t l u i a s and b l i n o p l e u r a l biopsy, and t h e d i a g n o s t i c u t i l i t y o f a standara panel o f monoclonal and p o l y c l o n a l antibodies on t i s s u e . There was a l a c k o f a s i a n i t i c a n t exposure h i s t o r y t o r asbestos i n t h e m a j o r i t y o t cases. I h e epidemiology o t non-asbestos r e l a t e d mesotheliomas w i l l be discusseo.
IT0 CELLS, CIRRHOSIS AND CANCER FOLLOWING DEFENESTRATION OF THE LIVER SlNUSOlDAL EN DOTHELIU M e n t s of Patholo and Sur ery, Christchurch School of Medicine, Christchurch Rospital. C%ristchurch, New Zealand Chylomicron remnants transporting dietary cholesterol and retinyl ester, enter the s ace of Disse through the open fenestrae in the sinusoiLl endothelium where they are extracted from circulation b specific receptors on the hepatocytes. Defenestration o r the human liver endothelium following alcohol abuse has been su ested as a mechanism for alcoholic hyperlipoproteinaemia. 8 o t only do chylomicron remnants continue to circulate, but the liver may also become depleted of vitamin A. Vitamin A is normally stored in the liver in the perisinusoidal lto cell (also known as the fat storin cell or lipocyte) which resides in the space of Disse. Ito celfs depleted of vitamin A transform into fibroblasts. In sclerosis around the hepatic venule, Ito cells increase in number, leadin to an increased matrix with basement membrane and coiagen under the sinusoidal endothelium and within the space of Disse. This stimulation of Ito cells may be triggered by a decrease in their vitamin A content, since the catabolism of chylomicron remnants may be hindered by the defenestration of the sinusoidal endothelium. Retinol is also known to influence the differentiation of epithelial cells; its lack may be related to carcinogenesis. We are currently examining the dimethyl nitrosamine fed rat as a model of cirrhosis and liver malignancy. This animal model, like the human alcoholic, shows early endothelial defenestration. Presenter: Assoc Prof Robin Fraser, Pathology Dept, CSM
Jli Keeling, l!oyal Hospital for Sick Childrerl, Edinburgh. Lxamination of the fetus fron pregnancies terminated for fetal anonaly should be done with great care. This should include a photographic and radiographic record as well as detailed external visceral description. Tissue should be retained for chrortiosor?e culture and 3:;A studies. Every effort s h o u l d be made t o confirm the diagnosis for which termination of pregnancy was undertaken. :onparison of scan diagnosis and pathological findings in 212 fetuses confirned the diagnosis in 117 and confirmed the major scan diagnoses but added useful inforrnation in a further 78 cases. In 17 fetuses, the ultrasound diagnosis was not upheld but another major anomaly was present in 16 and serious defornities in the final case. Although prenatal ultrasound examination for fetal anomaly is accurate in respect of major malformations, it lacks t h e specificity required for accurate parental counselling after delivery. Detailed pathological examination makes a major contribution to patient management and s h o u l d be undertaken i n every case.
P. b e t h r a i t e * , L. holloway, L. dories, b. Lelahunt, Lepartcent of Patholocry, b ' e l l i n g t o n School of F-ledicine (r L e p a r t r e n t o f k e s p i r a t o r y heoicine, k e l l i n g t o n h o s p i t a l , Wellington, New Zealand. hine cases o f d i f f u s e malignant m s o t h e l i o m a of t h e p l e u r a and peritoneum presented w i t h i n an e i g h t month p e r i o d t o our i n s t i t u t i o n . 'Ihe c l i n i c a l , a i a g n o s t i c and p a t h o l o c i c a l f e a t u r e s o f these cases were reviewed. In a d d i t i o n , a c o c p l e t e s o c i a l and occupational h i s t o r y was k obtained t r o r t h e p a t i e n t s o r t h e i r next-of-kin. nurber of i n t e r e s t i n o p o i n t s emerge t r o r t h i s case s e r i e s i n c l u d i n g t h e low y i e l d o f diagnosis u s i n g c y t o l o o i c a l e x a n i n a t i o n o f serous t l u i a s and b l i n o p l e u r a l biopsy, and t h e d i a g n o s t i c u t i l i t y o f a standara panel o f monoclonal and p o l y c l o n a l antibodies on t i s s u e . There was a l a c k o f a s i a n i t i c a n t exposure h i s t o r y t o r asbestos i n t h e m a j o r i t y o t cases. I h e epidemiology o t non-asbestos r e l a t e d mesotheliomas w i l l be discusseo.