臨牀消化器内科 Vol.25 No.11(1-4)


特集名 急性肝障害―薬物性肝障害とウイルス肝炎
題名 急性肝障害の診断 (4) 急性肝障害の病理所見
発刊年月 2010年 10月
著者 鹿毛 政義 久留米大学医学部病院病理部
著者 中島 収 久留米大学医学部病理学教室
【 要旨 】 急性肝障害をきたす疾患や病態は多種多様であり,その肝病理形態は多彩である.肝病理形態から,肝障害の成因や重症度の評価が可能である.ウイルス肝炎による急性肝炎の病理組織像は,肝細胞の風船化,好酸体など肝細胞障害像と門脈域の炎症細胞浸潤によって特徴づけられる.サイトメガロウイルスなどの肝炎ウイルス以外のウイルス感染の病理組織像は,通常,炎症は軽いが,まれに広汎な肝細胞壊死が生じる.うっ血肝では,うっ血が中心帯領域に生じ,重症のうっ血肝では,肝細胞壊死が肝小葉全体に広がる.Reye症候群や急性妊娠性脂肪肝などの疾患では,肝細胞に微小脂肪滴が沈着する.急性肝障害をきたす薬剤性肝障害の病理組織像のスペクトラムは広く,肝炎像,胆汁うっ滞,脂肪肝などが出現する.
Theme Acute Liver Injury : Drug-induced and Viral Liver Injuries
Title Pathological Features of Acute Liver Injury
Author Masayoshi Kage Department of Diagnostic Pathology, Kurume University Hospital, Kurume University
Author Osamu Nakashima Department of Pathology, Kurume University
[ Summary ] The number of diseases and pathological conditions associated with acute liver injury is diverse, as is the pathomorphology. The etiology and severity of liver injury can be evaluated based on the pathomorphology of the liver. The histological features of acute viral hepatitis include those of hepatocellular injury, such as the presence of ballooning hepatocytes and acidophilic bodies, as well as inflammatory cell infiltration of the portal tracts.
Histopathologically, infection with viruses other than the hepatitis virus usually causes mild inflammation, rarely resulting in extensive hepatocyte necrosis. Congestion of the liver is characterized by centrilobular congestion, and, in severe cases, by panlobular hepatocyte necrosis. In disorders such as Reye's syndrome and acute fatty liver of pregnancy, tiny fat droplets accumulate in the hepatocytes. Drug-induced acute liver injury encompasses a wide spectrum of histopathological features, including those associated with viral hepatitis, cholestasis, and fatty liver.
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