Shepherd N A, Dawson A M, Crocker P R, Levison D A
J Clin Pathol. 1987 Apr;40(4):418-23. doi: 10.1136/jcp.40.4.418.
Two contrasting cases of amiodarone hepatotoxicity are described. In one, perivenular collections of swollen cells, probably macrophages, with granular cytoplasm in an otherwise nearly normal liver were observed. Transmission electron microscopy showed that the cytoplasmic granularity was due to lysosomal bodies of various sizes. X-ray energy and wavelength spectroscopic analysis showed a high iodine content in these lysosomal bodies, good presumptive evidence of the presence of amiodarone or one of its metabolites. In the second case there was a micronodular cirrhosis, and similar granular cells also containing iodine were seen in the fibrous connective tissue. These cases seem to represent the very early and late stages of amiodarone hepatotoxicity. In a patient taking this drug aggregates of swollen granular cells may be a sensitive and histopathologically useful marker of early amiodarone toxicity.
描述了两例胺碘酮肝毒性的对比病例。在其中一例中，观察到在基本正常的肝脏中，肝小叶中央静脉周围有肿胀细胞（可能是巨噬细胞）聚集，细胞质呈颗粒状。透射电子显微镜显示，细胞质的颗粒性是由于大小各异的溶酶体所致。X射线能量和波长光谱分析显示，这些溶酶体中碘含量很高，有力地推测存在胺碘酮或其一种代谢产物。在第二例中，有小结节性肝硬化，在纤维结缔组织中也可见到类似的含碘颗粒细胞。这些病例似乎代表了胺碘酮肝毒性的极早期和晚期阶段。在服用该药的患者中，肿胀颗粒细胞的聚集可能是胺碘酮早期毒性的一个敏感且具有组织病理学意义的标志物。
