暂无摘要。

A 55-yr-old Palestinian man was admitted with a 1-month history of bi-temporal headache, proximal weakness and myalgia in the lower limbs. Both temporal arteries were swollen and tortuous. There was a moderate degree of cholestatic hepatic dysfunction. Temporal artery biopsy showed typical features of giant cell arteritis. Light microscopic examination of the liver showed no significant abnormality while electron microscopic (EM) examination revealed ultrastructural damage to the bile canaliculi. The patient improved dramatically on steroid therapy with normalization of cholestatic dysfunction. EM examination of a repeat liver biopsy 8 months later showed complete reversal of the biliary ultrastructural damage. The pathogenesis of the biliary injury remains uncertain.

A case of hepatitis induced by methyldopa and verified by means of challenge with the drugs is reported. The severe, chronic, aggressive inflammation greatly regressed after discontinuing the drug. The clinical differences, as well as those in laboratory findings disappeared. The electron-microscopic showed definite, but non-specific changes in the hepatic and sinusoidal mesenchymal cells. Our case was compared with the electromicroscopic picture of chronic aggressive hepatitis of unknown aetiology, and one essential difference was found in our hepatitis case as a result of methyldopa treatment: pathologic fibrogenesis did not occur. The rapid regression of the severe morphological picture can be attributed to this fact.

The investigators report an ultrastructural study of a case of primary biliary cirrhosis histologically in stage II (Scheuer), a rare disease which has not been investigated extensively at the ultrastructural level. Biliary canaliculi are dilated and microvilli are scarce. Large granular formations are observed in the perisinusoidal cytoplasm. The plasma membrane between adjacent hepatocytes appears convoluted. The ultrastructural alterations of the biliary canaliculi which we observed have been described in the literature in cholestatic patients and ascribed to cholestasis. Our patients, however, has never suffered episodes of jaundice or itching and has no histological signs indicating cholestasis. We suggest that these are precocious alterations which precede the appearance of clinical and histological signs of cholestasis. It is necessary to study other cases in order to evaluate the significance of the large granular formations and the changes observed in the plasma membrane.

A case of benign recurrent intrahepatic cholestasis was reported. A man had first experienced jaundice at the age of twenty-five, and suffered three subsequent attacks over the next five years. These attacks were characterized by prodromal severe pruritus. During the icteric phase, serum levels of total bile acids increased, most being conjugates of primary bile acids. Electron microscopy revealed that the bile canaliculi were filled with an increased volume of granular substances. Some bile canaliculi fused together resulting in the formation of abnormally elongated channels which abutted on the Disse space. These observations suggest bile regurgitation through the channel of altered canaliculi. In convalescence, these bile canaliculi disappeared. Every attack was followed by complete recovery of liver structure and function.

暂无摘要。

A case of biliary cystadenocarcinoma is presented in which the lesion seemed to partially differentiate into hepatocellular carcinoma. This patient had a cystic tumor in the left lobe of the liver, the interior being filled with papillary tumors. Histologic examination disclosed papillary growth of columnar tumor cells, together with tumor cells akin to hepatocytes (they had a distinct cell boundary, nuclear membrane, and nucleolus) showing a cobblestone appearance in some areas. Electron microscopic examination of this area showed bile canalicular structures. Histochemically, the tissue stained positively with the Luna-Ishak canalicular (LIC) technique; periodic acid-Schiff (PAS) staining demonstrated coexisting glycogen granulo-positive cells and mucus-producing cells. Thus, in this biliary cystadenocarcinoma, some tumor cells demonstrated the morphologic and histochemical features of hepatocytes.