Electron microscopic study of benign hepatoma in a patient on oral contraceptives

Fine structure of hepatocytes during the etiology of several common pathologies

Hepatocytes respond to injury by a few basic pathological reactions that are reflected in cell death, different types of degeneration, regeneration, or tumorous transformation. At the ultrastructural level, alterations of cell organelles can be observed in different combinations as a result of the injury, depending on the etiological agent(s) or pathological conditions developed. Nuclear bodies, dilation and fragmentation of rough endoplasmic reticulum (rer), swelling of mitochondria, and an increased number of lysosomes occur during acute viral hepatitis. The core and surface components of the hepatitis B virus can be localized in the liver cells in chronic hepatitis and in carriers. Close contact of hepatocytic and lymphocytic cell membranes were observed in chronic active hepatitis. Hepatocytes surrounded by an increased amount of collagen fibers are characteristic of cirrhosis. Loosely arranged, fine fibrils or condensed forms of Mallory bodies are pathognomic for alcoholic injury. A wide spectrum of alterations are noted after drug treatment: the proliferation of smooth endoplasmic reticulum (ser) as an adaptive phenomenon, focal or complete necrosis of the cell, inflammation, and the like. The fine structural analysis of hepatocytic inclusions in storage diseases has a differential diagnostic value. The storage of copper and other elements can be measured by x-ray microanalysis. The study of the hepatocytic differentiation in liver tumors is highly important in establishing the diagnosis and in proving the hepatocytic origin of the tumor.

Sinusoidal dilatation of the liver in patients on oral contraceptives. Electron microscopical study of 14 cases

Electron microscopic studies on sinusoidal dilatation of the liver were reported in 14 patients on oral contraceptives. The architecture of dilated sinusoids was preserved together with a striking perisinusoidal fibrosis. Proliferation and enhanced activity of sinusoidal endothelial cells and of perisinusoidal cells could be observed. The lumen of the dilated sinusoids was empty with no extravasation of the erythrocytes. The changes were different from peliosis hepatis described in association with the taking of androgenic-anabolic steroids.

Ultrastructure of sinusoidal cells in a benign liver cell adenoma

A typical benign liver cell adenoma was removed from a 25-year-old female taking an oral contraceptive. The biopsy was perfusion-fixed, allowing good visualization of sinusoids and sinusoidal cells. Kupffer cells were seldom seen. Endothelial cells were of irregular thickness; most of them had few fenestrae and were attached to each other by well visible junctions. Normal perisinusoidal cells (PSC) were not seen but were replaced by myofibroblast-like cells with thick subendothelial processes. A basement membrane often underlaid endothelial cells and the processes of PSC. The enlarged Disse space with a flattened sinusoidal hepatocyte membrane contained occasional red blood cells and an abundant extracellular matrix but few collagen fibers. These sinusoidal abnormalities leading to the capillarization of sinusoids, either the cause or the consequence of the disease, indicated a loss of normal hepatocyte homeostasis.

Relation of steroids to liver oncogenesis

Experience with pathological material from 150 women with liver tumors is reviewed. The features of liver cell adenoma and focal nodular hyperplasia are sufficiently different that the vast majority of the benign tumors can be easily subclassified. Although most occurred in women ingesting steroids, the wide usage of oral contraceptives makes it difficult to prove a causative role. Nineteen of the tumors were malignant and, to date, 12 of those patients have died of their disease. Since hepatomas are much more common than benign liver tumors, one must be even more circumspect in indicting steroids in their causation. In this group of women none had cirrhosis, whereas in the general population cirrhosis is a very common precedent lesion. Further investigation of estrogens and primary liver carcinoma would be timely.

Comparative electron-microscopic studies of benign hepatoma and icterus in patients on oral contraceptives

The author compared the electron-microscopic picture of 6 benign hepatomas and 3 specimens of icteric liver tissue in female patients on oral contraceptives. The majority of ultrastructural changes seen were identical in the tumor and non-tumor cases. It is noteworthy that there is an accumulation of filamentous substance of unknown origin in the bile canaliculi and in the Disse's spaces associated with a damage to the cell membrane. The electron-microscopic picture of the sinusoidal endothelial cells suggested an increased protein producing activity. The most conspicuous feature of the tumours was formation of continuous capillaries at the site of the sinusoids. The importance of systematic electron-microscopic investigation in studying the effect of oral contraceptives on the liver cells is stressed by the author.

[Ultrastructural-morphometric investigations on liver biopsies--the influence of oral contraceptives on the human liver (author's transl)]

Liver biopsies from 12 healthy women were investigated morphometrically--according to the methods of Weibel (1969). All women had taken an oral contraceptive agent during 2 til 76 months. The evaluated stereological datas were compared with base-line dates for normal human liver biopsies, which were elaborated in a previous investigation (Roessner et al., 1977). Statistical analysis was performed on an IBM 360/50 computer system, including F- and student's t-test. In the liver biopsy-specimen from the women, which were on oral contraceptives, the volume-density of lysosomes per ml hepatocytes shows a pronounced, significant (p less than 0.001) increase. A moderate increase of cytoplasm is combined with decrease of nuclei-volume. The surface-densities of the rough and smooth endoplasmatic reticulum do not differ significantly from the datas calculated from normal human liver biopsies. All other datas too demonstrate that there are no striking changes in the ultrastructure of human liver, caused by oral contraceptives. Functional alterations however can not be excluded.