Autoimmune morphology

Kuper, C.F. et al., Predictive testing for pathogenic autoimmunity the morphological approach, Toxicol. Lett., 112-113 433, 2000b. 

Examination of the bone marrow, although important, will only confirm that the hemopoiesis is megaloblastic. A deficiency of folic acid will also cause a megaloblastic anemia and it is not possible to identify the cause on the basis of morphology. A serum assay of both vitamins will usually indicate which is responsible. If the patient is vitamin B12 deficient, the next step is to carry out a vitamin B12 absorption test to confirm that the deficiency is due to a lack of intrinsic factor. Preferably this should not be done until the patient s vitamin B12 and hemoglobin levels have returned to normal, since the gastric and intestinal cells are also affected by a lack of vitamin B12 aborption may be less than optimal if it is attempted too early. Patients with pernicious anemia also have a histamine-fast achlorhydria and gastric atrophy. The disease appears to have an autoimmune basis and antibodies to intrinsic factor can be demonstrated in the serum of more than half of affected patients. 

Butovsky O, Hauben E, Schwai tz M (2001) Morphological aspects of spinal cord autoimmune neui oprotecdon Colocalizadon of T cells... 

Histologically, non-alcoholic steatohepatitis shows moderate to high-grade, mainly macrovesicular fatty degeneration of the liver cells with inflammatory infiltrates and formation of fibrosis. Cirrhosis frequently develops. Despite the morphological similarity to alcohol-induced fatty liver hepatitis, there is no (noteworthy) alcohol consumption involved in NASH. Viral or autoimmune hepatitis are not detectable either. There are no or only moderate subjective complaints. The transaminases are normal or slightly increased. NASH is mostly associated with obesity and/or type II diabetes, thus NASH is regarded as the hepatic manifestation of a metabolic syndrome. 

Kaserer, K., Exner, M., Mosberger, I., Penner, E., Wrba, F. Characterization of the inflammatory infiltrate in autoimmune cholangitis. A morphological and inununhistochemical study. Virch. Arch. 1998 432 217-222... 

Alcohol-related liver disease Approximately 80% of these patients display positive anti-histone 2B antibodies. In alcoholic hepatitis, there is frequent evidence of LMA (60%) and LSP (30%) as well as ANA and/or SMA. In autoimmune hepatitis (15% of cases), high litres of IgA antibodies to histone 2B can also be detected. This autoimmune situation in alcoholic liver disease can indeed give rise to therapeutic problems if, despite absolute abstinence, there is self-perpetuation of the morphological findings (as we ourselves noticed in some cases). 

Should cirrhosis be present at the time of initial diagnosis in the wake of confirmed pure autoimmune hepatitis (i. e. without HBV or HCV replication markers), it is advisable to implement combined immunosuppression - which is often successful in relatively low but sufficient dosage. Even if the morphological end-stage has already been reached, inflammatory activity can be repressed and clinical improvement achieved. The question of whether (and when) a liver transplantation should be planned always has to be considered. 

Renal morphology aftercyclosporin Atherapy in rheumatoid arthritis patients. International Kidney Biopsy Registry ofCyclosporin (Sandimmun) in Autoimmune Diseases. BrJ Rheumatol 1993 32Suppl 1 65-71. 

We need more information on the structure and ultrastructure of the thyroid in the two types of cretinism. We need to know whether there are specific aspects of thyroid morphology in hypothyroid newborns and stillbirths in endemic areas. We also need to know whether there are age-related changes in the thyroid of hypothyroid infants and children. In other words, how valid is the hypothesis that only progressive atrophy of the thyroid will result in permanent hypothyroidism and myxedematous cretinism in some individuals while the development of compensatory thyroid hyperplasia explains the transient character of hypothyroidism in others (5). Finally, is there any morphological evidence of an autoimmune process within the thyroid ... 

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