慢性肝炎の臨床病理學的知見

1. 慢性肝炎の肝生檢による病理像

抄録

Recently, a great deal of attention has been paied to the fact that various residual symptoms has been observed in many cases as a sequel of infectious hepatitis, and in some cases without such clinical symptoms, abnormalities in routine liver function tests have been demonstrated to persist long after disappearance of jaundice.
On the other hand, the possibility of transition of chronic hepatitis to liver cirrhosis has been discussed by many investigators.
Consequently, importance is stressed in clarifying the pathological features of chronic hepatitis and its relation to diagnosis, prognosis and treatment of this disease. But hitherto, there have been many discrepancies concerning the definition of chronic hepatitis.
Therefore, with special attention to various liver function, investigation was carried out on the histological features of biopsy specimens obtained with Turkel's trephine needle on 112 cases with chronic hepatitis. Diagnosis was made on basis of clinical and laboratory findings.
Analysis and classification of the pathological changes were made according to criteria set by the author in regards to cytological findings.
The most common changes characteristic of chronic hepatitis were found to be persistent interstitial inflammation. But the severity of the pathological condition may not be definitely diagnosed merely on evidence of the portal cellularity observed on such minute material obtained by means of needle biopsy, due to the fact that these changes do not occur eqally in all portal canals.
However, emphasis should be made on the changes in hepatic cells. Especially, in cases of chronic inactive hepatitis and those of post-hepatitis neurosis where no consistent pathological changes have been demonstrated, abnormalities such as swelling, as celled “Tache cláire” and acidophilic shrinkage of parenchymal cells, enlargement of nuclei, and increase in the ratio of the diameter of nucleoli to that of nuclei were noted.
Scarring of portal canals was frequently seen in cases with antecedant history of hepatitis, but this was also demonstrated in sine ictero cases without apparent history of hepatitis.
Suspicious evidence of the transition of chronic hepatitis to liver cirrhosis could also be demonstrated in serial studies on several cases.
Remarkable protoplasmic changes similar to Dubin Johnson's syndrome were also recognized in three cases.
In speculation to the results obtained in this investigation, the value of liver biopsy in the diagnosis of chronic hepatitis should be emphasized to a great extent.