CLINICAL LIVER MORPHOLOGY: RARE AND COMBINED LESIONS

Abstract

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.

Keywords

• combined and rare liver damage
• morphological diagnosis