Von Lichtenberg F, Erickson D G, Sadun E H
Am J Pathol. 1973 Aug;72(2):149-78.
When uniform histologic criteria are applied to staging schistosome egg and granuloma development in the hamster liver, the evolution of the egg foci is shown to be monophasic, albeit with considerable variation of the individual cell response. Both real and artifactual egg-granuloma asynchrony are demonstrable. Alternate granuloma stages occur simultaneously within the same single organ, so that necrosis or fibrous scarring may result in some lesions but not in others. The granulomas of Schistosoma japonicum, S mansoni and S haematobium show both shared and distinctive features. Thus, oviposition is serial in S mansoni but clustered in the other two species. Neutrophils are common in S japonicum granulomas but are rare in the others. The differential features, listed in detail, will usually permit histologic identification of species during the early stages of infection; subsequently, the species-specific features and the overall intensity of host reaction tend to decline. At comparable egg loads and time spans, the liver pathology of S japonicum is the most severe. This is not related to granuloma size, but rather to more exudation and necrosis in early S japonicum granulomas, their tendency to encroach on adjacent liver tissue and to more extensive diffuse inflammatory infiltration. Hoeppli phenomena occur around S japonicum eggs both in stellate form, and as intraovular "reverse" precipitates. Plasma cells and amyloid deposition are frequent. Conversely, S haematobium lesions are less destructive than those of S mansoni. These findings can be correlated, to some extent, with current knowledge of the biology of schistosomes and of the antigenic components of their eggs, but several key problems concerning the immunologic host response remain to be solved.
当采用统一的组织学标准对仓鼠肝脏内血吸虫卵及肉芽肿的发育进行分期时,卵灶的演变显示为单相性,尽管个体细胞反应存在相当大的差异。真实的和人为造成的卵-肉芽肿不同步现象均得到证实。同一单一器官内同时存在交替的肉芽肿阶段,因此坏死或纤维瘢痕形成可能导致部分病变出现,但并非所有病变都会如此。日本血吸虫、曼氏血吸虫和埃及血吸虫的肉芽肿既有共同特征,也有独特特征。因此,曼氏血吸虫产卵是连续的,而其他两种血吸虫产卵是成簇的。中性粒细胞在日本血吸虫肉芽肿中很常见,但在其他两种血吸虫肉芽肿中很少见。详细列出的这些差异特征通常能够在感染早期通过组织学鉴定血吸虫种类;随后,物种特异性特征以及宿主反应的总体强度往往会下降。在虫卵负荷和时间跨度相当的情况下,日本血吸虫引起的肝脏病变最为严重。这与肉芽肿大小无关,而是与日本血吸虫早期肉芽肿中更多的渗出和坏死、侵犯相邻肝组织的倾向以及更广泛的弥漫性炎症浸润有关。日本血吸虫卵周围会出现星状和卵内“反向”沉淀两种形式的何博礼现象。浆细胞和淀粉样物质沉积很常见。相反,埃及血吸虫病变的破坏性比曼氏血吸虫病变小。这些发现可以在一定程度上与目前对血吸虫生物学及其虫卵抗原成分的认识相关联,但关于免疫宿主反应的几个关键问题仍有待解决。