Portal tract lymph and blood vessels changes in human chronic viral hepatitis, schistosomiasis and hepatocellular carcinoma; immunohistochemical and morphometric study

Study of morphometric changes occurring in hepatic blood and lymph vessels in different chronic liver lesions with portal hypertension including viral hepatitis [B and C], Schistosomiasis and hepatocellular carcinoma [HCC] on top of cirrhosis, and to find the relationship of these changes to liver fibrosis, portal hypertension and HCC, using a combination of immunohistochemical and computer-based methodology. After clinco-pathoilogical evaluation of human patients with chronic hepatic lesion associated with portal hypertension, the chronic vital hepatitis C [n = 19], B and C [n = 12], Schistosomiasis [n = 10] and HCC on top of cirrhosis [n = 9] and 10 non-hepatic patients as control have been studied. Morphometric assessment of the number and area of blood vessels and lymphatics as well as the percentage of hepatic fibrosis per tissue section, all were done using computer soft-ware [KS 400] on image analysis system and using a combination of immuno-histochemical computer-based methodology. Immuno-histochernical staining of blood vessels, for factor VIII and portal lymphatic for a smooth muscle actin were done using monoclonal antibodies. Hepatic fibrosis was stained by sirius-red. Portal tract area and the relative fibrosis per liver tissue section were significantly increased with increasing grade of hepatitis activity in the non malignant groups compared to the control cases, with high significance in Schistosomiasis hut in HCC insignificant fibrosis compared to other disease and to control groups. There was a significant increase in the number of blood vessels per portal tract in the disease groups, highly significant in Schistosomiasis and HCC compared to the control cases but the percent of blood vessel area was significantly reduced in HCC than Schistosomiasis. This angiogenic change was directly proportional with grades of hepatitis activity and esophageal varices as it was significant with grade III activity and histological grade of HCC. There was significant increase in the number of lymphatic vessels per portal tract in all diseased groups with highest significance in Schistosomiasis group compared to the control group. There was insignificant increase in number and significant increases of area of lymphatics in HCC. This lymphangiogenesis change was directly proportional with grades of hepatitis activity but insignificant in all groups of patients. The advancement of hepatic fibrosis and portal hypertension in chronic liver disease including Schistosomiasis and viral hepatitis [B and C] was associated with significant increase in the number of both portal blood and lymphatic vessels. There was highly significant increase in the surface area of lymphatic vessels in Schistosomiasis. There was marked angiogenesis in HCC. Further study of these factors could be a target for further work

Endoscopic and histomorphometeric study of gastro-duodenal mucosa in portal hypertension

In 40 patients with that follow or complicate portal hypertension gastropathy [PHG] and duodenopathy [PHD] of hepatic etiology, histomorphometric measurement of mucosal vascular bed area through estimation of nuclear ploidy and proliferative index of epithelial mucosal cells showed that the incidence. [PHG and PHD] were 55% and 30% respectively. These incidences were significantly higher than that of 10 non portal hypertension controls and also significantly related to the degree of oesophageal varices [grade Ill and IV] and incidence of gastropathy, but not to the Child score of liver affection. It is concluded that portal hypertension was reflected more on gastric than duodenal mucosa. PHG and PHD predisposes to gastritis and ulceration and significantly raised the proliferative activity of gastric and duodenal mucosa. Congestion, inflammation and ulceration of gastro-duodenal mucosa following portal hypertension are contributing factors enhancing mucosal proliferation