CLINICAL LIVER MORPHOLOGY: RARE AND COMBINED LESIONS

Background. Morphological diagnosis of combined lesions of the liver of infectious and non-infectious etiology, as well as of primary and secondary origin is an actual problem. The purpose of the study is to present the morphological characteristics of rare and combined liver lesions of various etiologies and origins. Material and methods. The object of the study was liver biopsy specimens obtained by aspiration liver biopsy in patients with chronic diffuse liver lesions of various etiologies, as well as autopsy material. The most frequent combinations were the clinical variants, associated with immunosuppression (HIV infection), toxic and alcoholic liver damage, as well as secondary and rare liver damage. After fixation with 10% formalin solution, paraffin sections were stained with hematoxylin and eosin, with picrofuchsin according to Van Gieson, Masson, MSB, and according to Perls for iron as well as with congo red for amyloid. In some cases the antigens of HSV-1, HSV-2, EBV, CMV, HPV and HIV were revealed in paraffin sections of biopsy specimens with the help of the streptavidin-biotin method. Results and discussion. The incidence of tuberculous hepatitis associated with generalized hematogenous tuberculosis was 85.0%, and in association with secondary tuberculosis – only 30.8%. This type of hepatitis more often developed with the primary localization of the process in the lungs and intestines. Suppurative hepatitis was diagnosed as abscesses and diffuse suppurative inflammation. Actinomycosis of the liver was represented by 2 forms: destructive and destructive-proliferative. Echinococcal liver damage had cystic (hydatid or single-chamber) and alveolar (multi- compartment) forms. In the case of alveococcosis, the lesion in the liver had a knotty appearance, a whitish-yellowish color, and a dense consistency; on section it showed cavities filled with puriform fluid. The diagnosis of liver candidiasis is confirmed by the presence of yeast cells and pseudomycelium filaments in the granulomas. Syphilitic damage to the liver was characterized by chronic diffuse interstitial and productive-necrotic inflammation with the formation of gummas. In hemolytic disease of the newborn, foci of extramedullary hematopoiesis, hemorrhage, degeneration, necrobiosis, and hepatocyte necrosis were detected. Hemosiderosis was diagnosed in edematous and anemic forms and was pronounced in jaundice, in which besides erythroblastosis and widespread hemosiderosis, biliary stasis was also revealed. Conclusions. Due to the fact that the majority of chronic diffuse liver lesions of various etiologies are accompanied by similar morphological changes in the liver, the proposed algorithm of clinical and morphological diagnosis of combined liver lesions will provide methodological assistance to the hepatologist and morphologist in verifying the cause of the pathological process

CLINICAL MORPHOLOGY OF LIVER: BENIGN TUMORS

Background. Early diagnosis of benign liver tumors (BLT) is based on the use of methods for visualization of focal lesions of the liver. The final diagnosis of BLT is established using a comprehensive diagnosis, which includes a morphological study. The goal is to present the morphological characteristics of the BLT diagnosed in the Grodno region. Material and methods. The object of the study was liver biopsy sample obtained by performing aspiration liver biopsy in patients with focal liver disease, liver fragments excised during surgery, and also sectional material. Results. A detailed description of the morphological signs of the most frequently occurring focal lesions of the liver, referred to the BLT, is presented. Among the main BLT are tumors of epithelial and mesenchymal origin: hepatocellular adenoma, adenoma of the intrahepatic bile ducts, cystadenoma of the intrahepatic bile ducts, focal nodular hyperplasia, mesenchymal hamartoma, infantile hemangiendothelioma, hemangioma, adenomatous hyperplasia, liver damage by hematopoietic and lymphoid tissue, cysts, polycystic liver are different. Conclusion. For their morphological features BLT are different from malignant. However, under certain conditions, some BLT can increase to critical sizes, disrupt liver function, lead to complications in the form of internal bleeding and other negative consequences. The most unfavorable outcome of a number of BLT is their malignancy, which requires continuous monitoring of focal liver lesions by visualization methods, the study of molecular-genetic markers of early malignancy, and the use of morphological study of BLT (according to indications)

CLINICAL MORPHOLOGY OF LIVER: MALIGNANT TUMORS

Background. Among focal lesions of the liver, malignant liver tumors (MLTs) are recorded precisely. According to the WHO, MLTs are the fifth most frequent forms of cancer in men and the seventh in women and rank third among the causes of death from malignant neoplasms in the world. The goal is to present the morphological characteristics of MLT diagnosed in the Grodno region. Material and methods. The object of the study was liver biopsy samples obtained by performing aspiration liver biopsy in patients with suspected tumor process, liver fragments excised during surgery, and also - sectional material. Results. The international classification of MLT is presented. According to the classification, the most frequently diagnosed MLT in the Grodno region is described. The examples (pictures) of the main representatives of MLT are presented: primary and secondary, those of epithelial and mesenchymal origin. More detailed characteristics of hepatocellular and cholangiocellular liver cancer are given. Morphological signs of the tumors are indicated when performing differential diagnostics. Conclusions. Qualitative diagnostics of MLT, which is distinguished by a considerable variety, is possible when performing a complex morphological study carried out by experienced specialists using the methods of histological, immunohistochemical, and often ultrastructural analysis. Knowledge of the structural features of MLT will help increase the role of ultrasound and radiation diagnostics in the early stages of MLT

CLINICAL MORPHOLOGY OF THE LIVER: NECROSES

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

CLINICAL LIVER MORPHOLOGY: CYTOTOXIC LYMPHOCYTES

Background. The liver is the organ of the immune system, in which various populations of lymphocytes are representatives of congenital and acquired immunity: NK cells, NKT cells, LGL cells, CD8 + (CTL) cells that participate in cytotoxic reactions. The aim of the study is to present the structural and functional characteristics of the main populations of cytotoxic lymphocytes that take an active part in the development of inflammation in viral liver damage. Material and methods. Morphological evaluation of intravital hepatic biopsy specimens of patients with chronic viral hepatitis was performed by light and electron microscopy with the use of classical and original techniques for fixing and staining preparations. Results. A detailed description of the structure of the main populations of lymphocytes in the liver (NK cells, NKT cells, LGL cells, CD8 + cells) and their basic immunomorphological data and cytotoxic characteristics are presented. The main methods used in clinical practice for morphological evaluation of the activity of inflammation in the liver are described. Conclusions. The most studied participants in the development of cytotoxicity in chronic viral hepatitis are lymphocytes, which cause direct and indirect damage to hepatocytes: NK cells, NKT cells, LGL and CTL (CD8+ T cells) cells that differ by their phenotypic as well as structural and functional characteristics. The classical method of light microscopy of liver biopsy samples does not allow to differentiate populations of cytotoxic lymphocytes, in contrast to light microscopy of semi-thin sections and electron microscopy. An additional morphological indicator for the evaluation of activity and monitoring of inflammation in the liver can be a morphological (quantitative) characteristic of the cellular population of lymphocytes of the congenital and adaptive immunity

A CLINICAL CASE OF AСTH - INDEPENDENT SYNDROME OF ENDOGENOUS HYPERCORTICISM, REVEALED DURING PREGNANCY

A clinical case of ACTH-independent syndrome of endogenous hypercorticism revealed during pregnancy is presented. The checkup tactics and successful treatment of the syndrome of endogenous hypercorticism, caused by corticosteroma of the right adrenal gland are described in the article