Figure.11.13:-Phospholipidosis. Formation of
lysosomal inclusion bodies due to accumulation of amiodarone. Electron
micrograph.
Figure.11.14:- Sinusoidal obstruction syndrome. Endothelial
injury in small hepatic venules leads to luminal occlusion due to endothelial
swelling and thrombosis, and results in sinusoidal dilatation and congestion.
Figure.11.5:-
Peliosis. The hepatic parenchyma contains blood-filled cavities that lack an
endothelial lining (arrows).
Figure.11.16:-
Stellate cell (Ito cell) lipidosis. Fat-laden stellate cells showing multiple lipid
vacuoles with indentation of the nucleus. Note the location of Ito cells along
the sinusoids in the space of Disse.
Other patterns
Stellate cell
lipidosis
Hepatic stellate cells (Ito cells) are
modified fibroblasts that store lipids and vitamin A in the normal liver. They
are located in the space of Disse between the sinusoidal endothelium and the
hepatocytes but generally are not easily visible. In certain conditions,
especially hypervitaminosis A, excessive lipid gets stored in the stellate
cells (stellate cell lipidosis, fig 16). The nuclei of
stellate cells are crescent shaped, dark staining, and indented by the lipid
droplets. Thin strands of cytoplasm separate the lipid droplets. These
lipid-laden cells easily can be mistaken for hepatocytes with steatosis. Their
characteristic morphology and location along the sinusoids between the hepatic
plates distinguishes them from steatotic hepatocytes.
Hypervitaminosis A results from excess dietary/supplementary
vitamin A intake or use of oral/topical retinoids (such as etretinate for
acne). Stellate cell lipidosis also has been reported with methotrexate,
valproate and steroids, as well as in other clinical settings such as
cholestasis, alcoholic liver disease and hepatitis C.
Cytoplasmic inclusions
Ground glass change in the cytoplasm occurs in a minority of
patients with hepatitis B and is characterised by pale eosinophilic cytoplasmic
inclusions in hepatocytes. Similar changes (often termed “pseudo ground glass
change”, fig 17) can be seen with drugs
such as cyanamide, a drug used in alcohol treatment programs. This
phenomenon has also been described with other drugs such as barbiturates and
diazepam, diabetic patients on insulin, and transplant patients on multiple
immunosuppressive drugs such as steroids, tacrolimus and mycophenolate
mofetil. Similar to hepatitis B.
Figure.11.17:-
Ground-glass hepatocytes. This change can be seen with drugs such as cyanamide
(used for treating alcohol abuse), diazepam and barbiturates, and in patients
on insulin or intravenous glucose therapy
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