Andrade Z A, Peixoto E, Guerret S, Grimaud J A
Department of Pathology, Gonçalo Moniz Research Center, Baiha, Brazil.
Hum Pathol. 1992 May;23(5):566-73. doi: 10.1016/0046-8177(92)90135-p.
Destruction of intrahepatic portal vein branches with dispersion of smooth muscle cells into the periportal fibrosis and preservation of arterial and ductal structures were the main characteristic findings seen in 66 surgical liver biopsies from patients with the hepatosplenic form of schistosomiasis. Besides these diagnostic features, the present histologic, immunocytochemical, and ultrastructural study revealed the presence of a complex matrix forming the portal and septal fibrosis in advanced schistosomiasis. There was marked hyperplasia of elastic tissue, presence of several collagen isotypes (I, III, procollagen III, IV, and V), actin, desmin, fibronectin, and laminin in a richly vascularized connective tissue. Signs of multifocal matrix (collagen) degradation were observed both at light and electron microscopic levels, suggesting a predominance of a fibrolytic process, at the time parasite-related lesions had almost disappeared. The latter findings are related to the involution of periportal fibrosis now being observed in patients who have undergone antischistosomal chemotherapy. They exemplify morphologic changes connected with chronic collagen degradation in human schistosomiasis that are similar to those first seen in experimental material. Evidence of either persistent or active chronic hepatitis was seen in several cases but its etiology could not be determined.
肝脾型血吸虫病患者的66份手术肝活检标本的主要特征性表现为肝内门静脉分支破坏，平滑肌细胞分散至门周纤维化中，动脉和导管结构保留。除了这些诊断特征外，本次组织学、免疫细胞化学和超微结构研究还揭示，晚期血吸虫病中存在形成门静脉和间隔纤维化的复杂基质。在血管丰富的结缔组织中，弹性组织明显增生，存在多种胶原蛋白同型物（I、III、前胶原蛋白III、IV和V）、肌动蛋白、结蛋白、纤连蛋白和层粘连蛋白。在光镜和电镜水平均观察到多灶性基质（胶原）降解的迹象，这表明在与寄生虫相关的病变几乎消失时，纤维溶解过程占主导。后一项发现与接受抗血吸虫化疗的患者目前观察到的门周纤维化消退有关。它们例证了人类血吸虫病中与慢性胶原降解相关的形态学变化，这些变化与最初在实验材料中观察到的变化相似。在几例病例中可见持续性或活动性慢性肝炎的证据，但其病因无法确定。
