Jeffrey G P, Reed W D, Carrello S, Shilkin K B
Department of Medicine, University of Western Australia, Perth.
Gut. 1991 Apr;32(4):424-9. doi: 10.1136/gut.32.4.424.
The histological features and type of mononuclear cell infiltrate in gall bladders from six patients with primary sclerosing cholangitis were studied using routine staining techniques and immunohistochemistry. Control studies were performed using the gall bladders from six patients (age and sex matched) with chronic cholecystitis and four with primary biliary cirrhosis. A range of histological abnormalities was present in gall bladders from patients with primary sclerosing cholangitis including a mild to moderate degree of epithelial hyperplasia, pseudogland formation, and mononuclear cell infiltrate of the epithelium; moderate to severe chronic inflammatory cell infiltrate and fibrosis affecting the superficial and deep layers of the gall bladder wall; and minimal smooth muscle hypertrophy. These abnormalities were non-specific and were also present in gall bladders from patients with chronic cholecystitis and primary biliary cirrhosis. Vasculitis and granulomas were not present in the patients with primary sclerosing cholangitis. Immunohistochemistry showed that the superficial and deep mononuclear cell infiltrate in primary sclerosing cholangitis gall bladders was composed predominantly of lymphocytes, in contrast to chronic cholecystitis where macrophages were found in similar or greater numbers. Moreover, T lymphocytes (activated and resting) were present throughout the lymphocytic infiltrate and were apposed to the base and interdigitated between the biliary epithelial cells in significantly greater numbers than in chronic cholecystitis gall bladders. B lymphocytes were present only in lymphoid follicles. Comparative studies using liver biopsy specimens from three of the primary sclerosing cholangitis patients showed a similar T lymphocyte portal tract infiltrate. We conclude that a number of non-specific chronic inflammatory histological abnormalities were present in primary sclerosing cholangitis gall bladders. Immunohistochemistry found other features that were present in this disease - a predominantly lymphocytic mononuclear cell infiltrate of the superficial and deep layers of the gall bladder wall and the presence of T lymphocytes that infiltrated the biliary epithelial cells. These findings support the hypothesis that aberrant cell mediated immune mechanisms may play a role in the pathogenesis of both the intrahepatic and extrahepatic lesions in primary sclerosing cholangitis.
采用常规染色技术和免疫组织化学方法，对6例原发性硬化性胆管炎患者胆囊的组织学特征及单核细胞浸润类型进行了研究。对照研究采用了6例（年龄和性别匹配）慢性胆囊炎患者的胆囊以及4例原发性胆汁性肝硬化患者的胆囊。原发性硬化性胆管炎患者的胆囊存在一系列组织学异常，包括轻度至中度上皮增生、假腺形成以及上皮单核细胞浸润；中度至重度慢性炎性细胞浸润和纤维化累及胆囊壁的浅层和深层；以及轻微的平滑肌肥大。这些异常是非特异性的，也存在于慢性胆囊炎和原发性胆汁性肝硬化患者的胆囊中。原发性硬化性胆管炎患者未出现血管炎和肉芽肿。免疫组织化学显示，原发性硬化性胆管炎胆囊的浅层和深层单核细胞浸润主要由淋巴细胞组成，而慢性胆囊炎中巨噬细胞数量相似或更多。此外，T淋巴细胞（活化的和静止的）存在于整个淋巴细胞浸润中，并且与慢性胆囊炎胆囊相比，与胆管上皮细胞基部相邻并在其间相互交错的数量明显更多。B淋巴细胞仅存在于淋巴滤泡中。对3例原发性硬化性胆管炎患者的肝活检标本进行的比较研究显示，门静脉区有类似的T淋巴细胞浸润。我们得出结论，原发性硬化性胆管炎胆囊存在一些非特异性慢性炎性组织学异常。免疫组织化学发现了该疾病的其他特征——胆囊壁浅层和深层主要为淋巴细胞的单核细胞浸润以及浸润胆管上皮细胞的T淋巴细胞的存在。这些发现支持了异常细胞介导的免疫机制可能在原发性硬化性胆管炎肝内和肝外病变发病机制中起作用的假说。
