Hepatobiliary alterations in massive biliary ascariasis: histopathological aspects of an autopsy case

Gayotto, Luiz Carlos da Costa; Muszkat, Regina Maria Leitão; Souza, Irene Vieira

doi:10.1590/S0036-46651990000200005

Abstracts

Hepatobiliary alterations found in an autopsy case of massive Biliary Ascariasis, are reported on histological grounds. Severe cholangitis was the main finding, but other changes were also detected, such as pyloric and intestinal metaplasia, hyperplasia of the epithelial lining, with intraductal papillomas and adenomatous proliferation. Remnants of the worm were observed tightly adhered to the epithelium, forming microscopic intrahepatic calculi. Mucopolysaccharides, especially acid, showed to be strongly positive on the luminal border, and in proliferated glands around the ducts. The authors discuss the similarity between such findings and Oriental Cholangiohepatitis, and suggest that inflammation and the presence of the parasitic remnants are responsible for the hyperplastic and metaplastic changes, similarly with what occurs in chlonorchiasis, fascioliasis and schistosomiasis.

Ascariasis; Recurrent Pyogenic Cholangitis; Bile Ducts; Helminthic Infection

Os autores apresentam os aspectos histopatológicos encontrados no fígado de um caso de autópsia de Ascaridíase Biliar maciça. A intensa colangite foi o aspecto predominante, mas outras lesões também foram encontradas, tais como metaplasia pilórica e intestinal, hiperplasia epitelial com papilomas intraductais, e por vezes padrão adenomatoso. Restos do helminto foram encontrados fortemente aderidos ao epitélio, sendo intensa a positividade de mucopolissacárides, principalmente ácidos, na borda luminal do epitélio ductal e em glândulas proliferadas ao redor dos ductos. Os autores discutem a semelhança da Ascaridíase Biliar com a Colangio Hepatite Oriental, e sugerem que o processo inflamatório e a presença de restos do verme são responsáveis pelas alterações hiperplásicas e metaplásicas, analogamente ao que ocorre na clonorquíase, fasciolíase e esquistossomose.

CASE REPORT

Hepatobiliary alterations in massive biliary ascariasis. Histopathological aspects of an autopsy case

Lesões hepatobiliares em ascaridíase biliar maciça. Aspectos histopatológicos em um caso de autópsia

Luiz Carlos da Costa Gayotto^I; Regina Maria Leitão Muszkat^II; Irene Vieira Souza^III

^IDivisão de Anatomia Patológica do Hospital das Clínicas, e Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo

^IIUnidade de Fígado da Faculdade de Medicina da Universidade de São Paulo

^IIIDepartamento de Patologia do Centro de Ciências da Saúde da Universidade Federal de Santa Catarina

^{Address for correspondence} Address for correspondence: Prof. Dr. Luiz Carlos da Costa Gayotto Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo Av. Dr. Arnaldo, 455 CEP 01246 São Paulo, SP, Brasil

SUMMARY

Hepatobiliary alterations found in an autopsy case of massive Biliary Ascariasis, are reported on histological grounds. Severe cholangitis was the main finding, but other changes were also detected, such as pyloric and intestinal metaplasia, hyperplasia of the epithelial lining, with intraductal papillomas and adenomatous proliferation. Remnants of the worm were observed tightly adhered to the epithelium, forming microscopic intrahepatic calculi. Mucopolysaccharides, especially acid, showed to be strongly positive on the luminal border, and in proliferated glands around the ducts.

The authors discuss the similarity between such findings and Oriental Cholangiohepatitis, and suggest that inflammation and the presence of the parasitic remnants are responsible for the hyperplastic and metaplastic changes, similarly with what occurs in chlonorchiasis, fascioliasis and schistosomiasis.

Key words: Ascariasis, Recurrent Pyogenic Cholangitis; Bile Ducts; Helminthic Infection.

RESUMO

Os autores apresentam os aspectos histopatológicos encontrados no fígado de um caso de autópsia de Ascaridíase Biliar maciça. A intensa colangite foi o aspecto predominante, mas outras lesões também foram encontradas, tais como metaplasia pilórica e intestinal, hiperplasia epitelial com papilomas intraductais, e por vezes padrão adenomatoso. Restos do helminto foram encontrados fortemente aderidos ao epitélio, sendo intensa a positividade de mucopolissacárides, principalmente ácidos, na borda luminal do epitélio ductal e em glândulas proliferadas ao redor dos ductos.

Os autores discutem a semelhança da Ascaridíase Biliar com a Colangio Hepatite Oriental, e sugerem que o processo inflamatório e a presença de restos do verme são responsáveis pelas alterações hiperplásicas e metaplásicas, analogamente ao que ocorre na clonorquíase, fasciolíase e esquistossomose.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Recebido para publicação em 02/8/1989.

1. ACOSTA-FERREIRA, W.; VERCELLI RELTA, J. & FALCONI, L.M. Fasciola hepatica human infection. Histopathological study of sixteen cases. Virchows Arch, Abt. A. path. Anat., 383: 319-327, 1979.
2. BENENSON, A.S. El control de las enfermedades transmisibles en el hombre. Washington, PAHO; WHO, 1983.
3. CHOU, S.T. & GIBSON, J.B. The histochemistry of biliary mucins and the changes caused by infestation with clonorchis sinensis. J. Path., 101: 185-197, 1970.
4. DEMERAU, E.F. Tratamento da ascaridíase das vias biliares: contribuiçăo ao seu estudo. Santa Catarina, 1974. (Tese de Livre Docęncia Universidade Federal de Santa Catarina).
5. EVANS, H.; BURGEOIS, C.H.; COMER, D.S. & KESCHAMARAS, N. Biliary changes in opisthorchiasis. Amer. J. trop. Med. Hyg., 20: 667-671, 1971.
6. HOU, P.C. The pathology of Chlonorchis sinensis infestation of the liver. J. Path. Bact., 70: 53-64, 1955.
7. HOU, P.C. The relationship between primary carcinoma of the liver and infestation with Chlonorchis sinensis. J. Path. Bact., 72: 239-246, 1956.
8. HSU, F.H. Clinical observation on 110 cases of Ascaris invasion into the biliary tract. Nagoya J. med. Sci., 24: 215-233, 1962.
9. KHUROO, M.S. & ZARGAR, S.A. Biliary Ascariasis. A common cause of biliary and pancreatic disease in an endemic area. Gastroenterology, 88: 418-423, 1985.
10. KOSUKA, S.; KURASHIVA, M.; TSUTONE, M.; HACHISUKA, K. & YASUI, A. Significance of intestinal metaplasia for the evolution of cancer in the biliary tract. Cancer, 54: 2277-2285, 1984.
11. MARCIAL, M.A. & MARCIAL-ROJAS, R.A. Parasitic diseases of the liver. In: SCHIFF, L. & SCHIFF, E.R., ed. Diseases of the liver. Philadelphia, J. B. Lippincott, 1987. p. 1171-1196.
12. SCHULMAN, A. Non-western patterns of biliary stones and the role of Ascariasis. Radiology, 162: 425-430, 1987.
13. TEOH, T.B. A study of gall-stones and included worms in recurrent pyogenic cholangitis. J. Path. Bact., 86: 123-130, 1963.
14. VIANNA, M.R.; GAYOTTO, L.C.G.; SANTOS, R.T.M.; ALVES, V.A.F.; FUKUSHIMA, J. & BRITO, T. de Intrahepatic bile duct changes in human hepatosplenic schistosomiasis mansoni. Liver, 9: 100-109, 1989.
15. WEN, C. & LEE, H. Intrahepatic stones: a clinical study. Ann. Surg., 175: 166-177, 1972.
16. YELLIN, A.G. & DONOVAN, A. Biliary lithiasis and helminthiasis. Amer. J. Surg., 142: 128-136, 1981.

Address for correspondence:

Prof. Dr. Luiz Carlos da Costa Gayotto

Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo

Av. Dr. Arnaldo, 455

CEP 01246 São Paulo, SP, Brasil

Publication Dates

Publication in this collection
13 Sept 2006
Date of issue
Apr 1990

History

Received
02 Aug 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ACOSTA-FERREIRA, W.; VERCELLI RELTA, J. & FALCONI, L.M. Fasciola hepatica human infection. Histopathological study of sixteen cases. Virchows Arch, Abt. A. path. Anat., 383: 319-327, 1979.

[2] 2. BENENSON, A.S. El control de las enfermedades transmisibles en el hombre. Washington, PAHO; WHO, 1983.

[3] 3. CHOU, S.T. & GIBSON, J.B. The histochemistry of biliary mucins and the changes caused by infestation with clonorchis sinensis. J. Path., 101: 185-197, 1970.

[4] 4. DEMERAU, E.F. Tratamento da ascaridíase das vias biliares: contribuiçăo ao seu estudo. Santa Catarina, 1974. (Tese de Livre Docęncia Universidade Federal de Santa Catarina).

[5] 5. EVANS, H.; BURGEOIS, C.H.; COMER, D.S. & KESCHAMARAS, N. Biliary changes in opisthorchiasis. Amer. J. trop. Med. Hyg., 20: 667-671, 1971.

[6] 6. HOU, P.C. The pathology of Chlonorchis sinensis infestation of the liver. J. Path. Bact., 70: 53-64, 1955.

[7] 7. HOU, P.C. The relationship between primary carcinoma of the liver and infestation with Chlonorchis sinensis. J. Path. Bact., 72: 239-246, 1956.

[8] 8. HSU, F.H. Clinical observation on 110 cases of Ascaris invasion into the biliary tract. Nagoya J. med. Sci., 24: 215-233, 1962.

[9] 9. KHUROO, M.S. & ZARGAR, S.A. Biliary Ascariasis. A common cause of biliary and pancreatic disease in an endemic area. Gastroenterology, 88: 418-423, 1985.

[10] 10. KOSUKA, S.; KURASHIVA, M.; TSUTONE, M.; HACHISUKA, K. & YASUI, A. Significance of intestinal metaplasia for the evolution of cancer in the biliary tract. Cancer, 54: 2277-2285, 1984.

[11] 11. MARCIAL, M.A. & MARCIAL-ROJAS, R.A. Parasitic diseases of the liver. In: SCHIFF, L. & SCHIFF, E.R., ed. Diseases of the liver. Philadelphia, J. B. Lippincott, 1987. p. 1171-1196.

[12] 12. SCHULMAN, A. Non-western patterns of biliary stones and the role of Ascariasis. Radiology, 162: 425-430, 1987.

[13] 13. TEOH, T.B. A study of gall-stones and included worms in recurrent pyogenic cholangitis. J. Path. Bact., 86: 123-130, 1963.

[14] 14. VIANNA, M.R.; GAYOTTO, L.C.G.; SANTOS, R.T.M.; ALVES, V.A.F.; FUKUSHIMA, J. & BRITO, T. de Intrahepatic bile duct changes in human hepatosplenic schistosomiasis mansoni. Liver, 9: 100-109, 1989.

[15] 15. WEN, C. & LEE, H. Intrahepatic stones: a clinical study. Ann. Surg., 175: 166-177, 1972.

[16] 16. YELLIN, A.G. & DONOVAN, A. Biliary lithiasis and helminthiasis. Amer. J. Surg., 142: 128-136, 1981.

Brasil