Clinical significance of emperipolesis in autoimmune hepatitis

Abstract

Abstract: Objective To investigate the incidence and clinic significance of emperipolesis in autoimmune hepatitis (AIH) patients in China. Methods A histological evaluation by hematoxylin-eosin staining in all AIH patients was performed. Assessment of Ishak score was carried out for intrahepatic inflammation or fibrosis, as well as evaluation of interface hepatitis, plasma cell infiltration and rosette formation in the liver. Then the incidence of emperipolesis was analyzed statistically in patients with AIH. Furthermore, the relation of emperipolesis with intrahepatic inflammation or fibrosis and other pathological characteristics of AIH were analyzed. Results The presence of emperipolesis was observed in 57.3% AIH cases which was with hepatocyte eosinophilic stained. The incidence of emperipolesis showed positive correlations with the aggravation of intrahepatic inflammation or fibrosis. Histologically, patients with emperipolesis had higher incidences of interface hepatitis and rosette formation as compared with patients without emperipolesis. Conclusion Emperipolesis might be an important pathological hallmark for AIH, which might even illustrate a novel mechanism of hepatocyte damage in AIH.

Key words: Emperipolesis, Autoimmune hepatitis, Interface hepatitis, Rosette

BIAN Zhao-lian, QIN Gang, CHEN Lin, SHAO Jianguo, MIAO Qi, MA Xiong. Clinical significance of emperipolesis in autoimmune hepatitis[J]. Chinese Hepatolgy, 2016, 21(9): 729-732.

References

[1] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会感染病学分会. 自身免疫性肝炎诊断和治疗共识(2015). 肝脏,2015,24:969-982.
[2] Humble JG, Jayne WH, Pulvertaft RJ. Biological interaction between lymphocytes and other cells. Br J Haematol, 1956, 2: 283-294.
[3] Overholtzer M, Brugge JS. The cell biology of cell-in-cell structures. Nat Rev Mol Cell Biol, 2008, 9:796-809.
[4] Sandilands GP, Reid FM, Gray KG, et al. Lymphocyte emperipolesis revisited. I. Development of in vitro assay and preliminary characterisation of the lymphocyte subpopulation involved. Immunology, 1978, 35:381-389.
[5] Dienes HP. Viral and autoimmune hepatitis. Morphologic and pathogenetic aspects of cell damage in hepatitis with potential chronicity. Veroff Pathol, 1989, 132:1-107.
[6] Hennes EM, Zeniya M, Czaja AJ, et al. Simplified criteria for the diagnosis of autoimmune hepatitis. Hepatology, 2008, 48:169-176.
[7] Suzuki A, Brunt EM, Kleiner DE, et al. The use of liver biopsy evaluation in discrimination of idiopathic autoimmune hepatitis versus drug-induced liver injury. Hepatology, 2011, 54:931-939.
[8] Qiu D, Wang Q, Wang H, et al. Validation of the simplified criteria for diagnosis of autoimmune hepatitis in Chinese patients. J Hepatol, 2011, 54:340-347.
[9] Yang YQ, Li JC. Progress of research in cell-in-cell phenomena. Anat Rec (Hoboken), 2012, 295:372-377.
[10] Larsen TE. Emperipolesis of granular leukocytes within megakaryocytes in human hemopoietic bone marrow. Am J Clin Pathol, 1970, 53:485-489.
[11] Sinkovics JG, Shullenberger CC, Howe C, et al. Cell destruction by lymphocytes. Lancet, 1966, 287:1215-1216.
[12] Saxena S, Beena KR, Bansal A, et al. Emperipolesis in a common breast malignancy. A case report. Acta Cytol, 2002, 46:883-886.
[13] Chen YH, Wang S, He MF, et al. Prevalence of heterotypic tumor/immune cell-in-cell structure in vitro and in vivo leading to formation of aneuploidy. PLoS One, 2013, 8:e59418.
[14] Natori H, Natori K, Naito K, et al. Emperipolesis by megakaryocytes in RAEB in T (refractory anemia with excess of blasts in transformation). Rinsho Ketsueki, 1988, 29:1504-1510.
[15] Djaldetti M, Strauss Z. Emperipolesis by megakaryocytes in patients with non-Hodgkin' lymphoma and megaloblastic anemia. J Submicrosc Cytol, 1982, 14:407-413.
[16] Weiler-Normann C, Lohse AW. Autoimmune hepatitis: A life-long disease. J Hepatol, 2013, 58:5-7.
[17] Longhi MS, Ma Y, Mieli-Vergani G, et al. Aetiopathogenesis of autoimmune hepatitis. J Autoimmun, 2010, 34:7-14.
[18] Zhao L, Tang Y, You Z, et al. Interleukin-17 contributes to the pathogenesis of autoimmune hepatitis through inducing hepatic interleukin-6 expression. PLoS One, 2011, 6:e18909.
[19] Miao Q, Bian Z, Tang R, et al. Emperipolesis Mediated by CD8 T Cells Is a Characteristic Histopathologic Feature of Autoimmune Hepatitis. Clin Rev Allergy Immunol, 2015, 48:226-235.