Clinico-biochemical evolution and late hepatic lesions in the toxic oil syndrome

The clinical and biochemical evolution of hepatic lesions in 124 patients with toxic oil syndrome from 1981 to 1986 has been reviewed. Most patients became asymptomatic during the early phase of the disease and abnormal liver function tests gradually normalized. In 1981, liver injury resembled drug-induced cholestatic hepatitis in 31 patients, and in 1 patient chronic destructive nonsuppurative cholangitis was evident. From 1982 to 1986 serial liver biopsies demonstrated toxic cholestatic hepatitis in 14 patients, chronic active hepatitis in 13, and nonalcoholic cirrhosis in 4. Nineteen patients showed lesions suggestive of alcoholic liver disease, but only 8 had a history of heavy alcohol intake. One patient developed biliary cirrhosis, another liver cell adenoma, and 8 nodular regenerative hyperplasia of the liver. We conclude that although liver injury had subsided in most patients, a significant number developed a variety of different liver diseases after follow-up for 5 yr.

Nodular regenerative hyperplasia of the liver associated with the toxic oil syndrome: report of five cases

Nodular regenerative hyperplasia of the liver developed in five patients who had the toxic oil syndrome caused by ingestion of adulterated cooking oil. This hepatic complication was detected from 19 to 37 months (mean-2.5 years) after the onset of the toxic oil syndrome. Nodular regenerative hyperplasia was asymptomatic, although all patients had persistently abnormal liver function. Hepatomegaly was present in four cases, mild jaundice in three and signs of portal hypertension in two. Pathogenesis of nodular regenerative hyperplasia in toxic oil syndrome is unknown, but probably microcirculatory disturbances within the liver might have played a role. Fibrosis in Zone 3, sinusoidal dilatation and occasionally intralobular hemorrhage were seen in three cases; in one of them, characteristic lesions of veno-occlusive disease were also present. In another case, endarteritis changes of hepatic arterioles were evident.

Primary adenocarcinoma of the terminal ileum simulating Crohn's disease

An unusual case of histologically proven ileal adenocarcinoma mimicking regional enteritis in a 22-year-old man is reported. Although in 2 previous reports the patient's age was stressed as an important factor for the differential diagnosis, this was not of diagnostic help in our case. This report emphasizes the need to include other diagnostic possibilities when regional enteritis has an anomalous evolution and responds poorly to treatment.

Laparoscopic and histological problems in the diagnosis of nodular regenerative hyperplasia of the liver

We describe the laparoscopic findings in 5 patients with nodular regenerative hyperplasia of the liver (NRH). A nodular liver surface and signs of portal hypertension were observed, which in all cases gave rise to the laparoscopic diagnosis of liver cirrhosis. Multiple and single liver biopsies in 3 and 2 cases respectively, permitted the definitive diagnosis of the NRH lesion. The laparoscopic picture of NRH is indistinguishable from that of cirrhosis, and for this reason it is advisable to carry out liver biopsy even in cases where cirrhosis seems unquestionable.

Structural hepatic changes associated with cyanamide treatment: cholangiolar proliferation, fibrosis and cirrhosis

The authors present the clinical and histological findings in a series of 42 liver biopsies from 39 chronic alcoholics treated with cyanamide as aversion therapy. All biopsies displayed characteristic cytoplasmic inclusions in the liver-cells. Fibrosis and disruption of the parenchymal-connective tissue interface were observed in all cases. According to the severity and extension of fibrosis, three stages could be depicted: Stage I. Periportal activity cholangiolar type (ACT), which is defined by cholangiolar proliferation, fibroblastic activation and inflammatory infiltrate, which together cause a blurred appearance of the parenchymal-connective tissue junction. It is the elementary lesion and was observed alone in 26 biopsies. Stage II. Portal-to-portal linkage. It was observed in 10 biopsies, all of which also showed periportal ACT. Three of these came from patients with two biopsies in which transition from stage I (first biopsy) to stage II (second biopsy) was observed. Stage III. Nodular parenchymal regeneration, associated with changes observed in stage I and II. It was found in six patients. The histological picture resembles the biliary type of cirrhosis. There is a clear-cut correlation between the length of treatment and the stage of the hepatic lesion.

Hepatic injury in the toxic epidemic syndrome caused by ingestion of adulterated cooking oil (Spain, 1981)

We describe the clinico-pathological characteristics of hepatic injury associated with the toxic-epidemic syndrome caused by the consumption of adulterated rapeseed oil. Of 842 toxic-epidemic syndrome patients admitted to our hospital between May, 1981, and January, 1982, 24.1% showed signs of liver involvement which was more frequent in women and in the fourth decade of life. No statistical significance was found in relation to alcohol consumption, treatment with potentially hepatotoxic antibiotics, or adult respiratory distress syndrome. Most (91.6%) patients with hepatic injury were asymptomatic; jaundice or abdominal pain was rarely noted. One patient died of acute liver failure following Budd-Chiari syndrome. Serum gamma-glutamyl transpeptidase activity was raised in all cases, alkaline phosphatase in 94.6%, and less frequently lactate dehydrogenase (80%), SGPT (84.7%), and SGOT (76%). Serum total bilirubin was usually normal (89.2%). The histologic lesion was similar to drug-induced cholestatic hepatitis. Lamellar inclusions, canalicular injury, giant mitochondria, and hyperplasia of the smooth endoplasmic reticulum were seen by electron microscopy. Ultrastructural signs of cholestasis were common (78.9%). The pathogenesis of this lesion is unknown; however, because of similarities with chlorpromazine-induced cholestatic hepatitis, we suggest that a combination of hypersensitivity and intrinsic hepatoxicity is a possible mechanism.

Reddish-purple areas on the liver surface: the laparoscopic picture of peliosis hepatis

Reddish-purple areas occasionally found on the surface of the liver have been related to peliosis hepatis. The purpose of the present study was to determine: 1) the frequency of these changes in a total of 3035 laparoscopies and 2) the histological substrate of these laparoscopical changes. In 20 cases (0.65%), reddish-purple patches of round, triangular, star-shaped or net-work configuration were found on the liver surface. Liver biopsies taken from these areas showed: 1) dilatation of sinusoids; 2) blood-filled cavities, and 3) intralobular hemorrhages. These lesions were frequently combined. In three cases no lesions were found. The presence of these histological lesions was compared with those found in a group serving as controls, in whom no reddish-purple spots were seen at laparoscopy. Our study shows that there is a close statistical relationship (X2: 19.01; p less than 0.001) between the histological and laparoscopic changes. We conclude that: 1) Reddish-purple areas on the liver surface are caused by Peliosis hepatis or are Peliosis hepatis-related lesions, and 2) Peliosis hepatis is not an extremely rare condition in laparoscopy.

Clinical implications of the presence of refractile particles in the liver of haemodialysis patients

In a retrospective study we have examined 20 liver specimens from haemodialysis patients with a mean time on treatment of 27 months. Thirteen specimens were biopsies, the remaining came from autopsies. The presence of refractile particles was found in 55 per cent of biopsies and 100 per cent of autopsies. Its presence was not constantly associated with morphological lesions of the liver. We believe that the deposition of this material could be a fortuitous finding with uncertain clinical implications.

Nodular regenerative hyperplasia of the liver. Report of two cases associated with autoimmune disease

Nodular regenerative hyperplasia of the liver (N.R.H.) is an uncommon clinicopathological entity characterized by diffuse regenerative hepatocytic nodules without fibrosis. Grossly the lesion is often mistaken for cirrhosis. The etiology and pathogenesis are unknown. We report two new cases of N.R.H. diagnosed by liver biopsy. Peritoneoscopically the liver showed a nodular surface resembling micronodular cirrhosis. Both patients showed some clinical and immunological features of autoimmune disease, and in both cases N.R.H. was associated with chronic active hepatitis. We discuss the pathological differential diagnosis of N.R.H., its relation to other associated diseases and review the hypotheses for the pathogenesis of this condition.

Collagenous colitis: the clinical and morphological features

A woman aged 23 years is described who had watery diarrhoea and colicky abdominal pain with normal results on sigmoidoscopy and barium enema. Rectal biopsy showed a thick layer of collagen in the lamina propria below the free epithelial surface. This lesion extended throughout the length of the descending colon. The only change revealed by electron microscopy was an increase in the thickness of the sub-epithelial collagen layer which is normally present in the colon. The maturation of the fibroblasts was normal. The lesion in this patient may be considered as a small change from the normal situation. This lesion is typical of ‘collagenous colitis’ of which only three other cases have as yet been published.

Squamous papilloma of the esophagus. A report of three cases and review of the literature

We present three cases of squamous papilloma of the esophagus (SPE) diagnosed by esophagoscopy and confirmed by histology. All cases had previous history of heartburn. Specific etiological factors, including viruses, were sought in the three cases, with negative results.