Mesenchymal reaction

As long as the interaction between the liver and the causative factor (viruses, toxins, noxae, etc.) is restricted to the mesenchyma or the connective tissue (particularly within the periportal field), i. e. if directly adjacent hepa-tocytes have not as yet been damaged, no rise in transaminase levels (GPT, GOT) is to be expected in laboratory examinations. These mesenchymal reactions range from signs of portal inflammation (cellulation, oedema. 

This virus species derived its name from the town of Coxsackie in the state of New York, where virological evidence thereof was successfully obtained for the first time. Coxsackie viruses are assigned to the picornavirus group, consisting at present of 23 A and 6 B types. Coxsackie hepatitis with mesenchymal reactions, portal infiltration and focal hepatocellular necrosis sometimes occurs, especially in infants. Cholestatic, predominantly centrolobular forms of the disease, can develop in adults. A lethal course is extremely rare. (66-68) The course of infection with the Coxsackie type B4 or B5 virus may give rise to the Fitz-Hugh-Curtis syndrome with the development of the typical violin string-like adhesive strands. (65) (s. fig. 24.2)... 

Non-specific mesenchymal reactions The reaction to acute intestinal affection from Ent. histolytica consists of moderate diffuse swelling and multiplication of the stellate cells. Other morphological lesions are generally not detectable. The liver may be enlarged and sensitive to pressure. 

The trichinae also reach the liver, where they invade the sinusoids and may cause an inflammatory mesenchymal reaction. There is likewise an abundance of liver granulomas. (69, 70) Treatment for trichinosis during the motile phase consists of mebendazole and possibly thiabendazole (in gradually increasing dosage, with additional administration of glucocorticoids, if necessary). 

The pattern of damage is as follows steatosis, necrosis and cholestasis. They occur either as defined individual phenomena or (more frequently) in combination. Depending on the severity and extent of these morphological findings, two forms of inflammatory reaction are possible (1.) mesenchymal reaction and (2.) cellular infiltration. 

Mesenchymal reaction shows an activation of the stellate cell system the stellate cells and the mononuclear phagocytosis system proliferate, (s. p. 397) Stellate cell nodules form. (s. fig. 22.3) This process spreads from the sinusoids at the site of the lesion to include neighbouring parenchymal cells. The reticular lattice fibre is damaged and sometimes even destroyed. In a more massive lesion, the inflammatory process spreads to the portal zone histiocytes, lymphocytes and eosinophilic leucocytes lead to portal zone cellulations with oedematous dilations, in some cases subsequent to portal fibrosis (s. fig. 21.14), or to cholangitis of the PBC type (s. fig. 29.5) as well as of the PSC type. 

A disease of epidemic proportions affected more than 1,000 persons in India in 1974. The patients suffered from jaundice and ascites. Histological examination revealed centroacinar necrosis, inflammatory mesenchymal reactions and bile-duct proliferation fibrosis and septal formation, sometimes ultimately cirrhosis, were determined. Mortality was 10%. The cause was thought to be the additive effect of several unidentified mycotoxins (B.N. Tandon et al., 1977). 

The inflammatory mesenchymal reactions in the portal field and lobular periphery induce extremely low-cell perilobular and tylotic fibrosis. (425, 442) Slowly, starshaped portal fibrosis, so-called holly-leaf fibrosis, develops. This morphological picture, similar to that of chronic hepatitis, was termed chronic siderophile hepatitis by H. Kalk (1962). The hepatic lobules are gradually... 

Fig. 206. Cotton pellet granuloma 7 days after subcutaneous implantation in a 120 g male Sprague-Dawley rat medicated with 15 mg carbocromene/kgxday for 14 days. The mesenchymal reaction is increased compared with an unmedicated control (Fig. 205). Giant cells are going to wrap the inmvidual cotton fibres. Fixed by immersion in Bouin s fluid. Paraplast 4 xm. Haematoxy-lin and eosin. Objective Leitz Pi 40/0.65. Leitz-Orthomat. Agfachrome 50 L professional...

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