Needle Biopsy of the Liver and Spleen in Schistosomiasis: A Histopathologic Study

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Abstract
Histologic findings in material obtained by needle biopsy from 61 patients whose livers revealed schistosome eggs, or granulomas, or both are described. Needle biopsy of the spleen was also used in 31 patients to study and correlate the findings with those observed in the livers. Only 41.7% of this group of patients were passing eggs at the time they were studied. Needle biopsy material from the livers of 54 patients who manifested laboratory evidence of schistosomiasis in the urine, or stools, or both, was also studied histologically; about 53.7% of the livers revealed eggs or granulomas. The overall rate of hepatic involvement in schistosomiasis was 70.8%. Eighteen patients with find-ings histologically consistent with hepatic schistosomiasis, but revealing no eggs despite serial sectioning of the liver tissue, were excluded from this study. Species differentiation of the schistosoma was possible in only 18% of the cases. The authors believe that the histologic alterations in the liver are directly caused by the parasites. Varying degrees of periportal fibrosis were present in 92%. A severe degree of fibrosis was noted in 28.3% of the livers, these including 5 cases of portal cirrhosis. Needle biopsy is indicated in all cases of hepatomegaly associated with schistosomiasis, since these patients may suffer from coexistent or unrelated hepatic diseases. This is necessary in planning the right type of treatment, prior to the surgical intervention for relief of the portal hypertension, and in the assessment of therapy. The histopathologic changes of the enlarged spleens accompanying hepatic schistosomia-sis are attributable to the raised portal pressure and, apart from the presence of schistosome pigment, are nonspecific. A definite relation was established between the degree of hepatic and splenic fibrosis, as well as between the degree of hepatic fibrosis and dilatation of the splenic sinuses. Needle biopsy of the spleen is indicated in patients suffering from advanced schistosomiasis in whom the liver is shrunken and difficult to biopsy.

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