Evaluation of morphological changes of the liver caused by heroin abuse in forensic practice

Abstract

Background/Aim. A study of morphological lesions in the liver of heroin addicts enables a precise overview of the type and degree of the liver damages caused by intravenous (iv) heroin abuse, additive effects of viral infections and alcohol consumption, as well as whether the expressiveness of these lesions depends on the duration of the time period of heroin application. The aim of the study was to investigate histopathological, ultrastructural and morphometric features of the liver of heroin addicts in forensic samples of the liver. Methods. The study involved the autopsy conducted on 40 bodies of iv heroin addicts and 10 control autopsies. The investigated group consisted of liver samples of 36 male subjects and 4 female subjects aged 35-40 years and the control group of 8 male and 2 female cadaveric bodies aged 15-35 years. The liver tissue samples were prepared for light microscopy. Sections of the tissue paraffin blocks 5 ? thick were stained using classical Hematoxylin and Eosin method (H&E), as well as PAS Van Gieson, Gomori, and Congo Red techniques. For investigation purposes of ultrastructural changes, liver tissue was fixed in glutaraldehyde and molded with epon. The analysis was performed using the method of transmission electron microscopy. Morphometric investigation of the liver sinusoidal macrophages was performed by using the M42 test system. Results. In the investigated group of iv heroin addicts, the liver autopsy samples showed degenerative vesicular and fat changes, chronic hepatitis, cirrhosis, sedimentation of pathologic protein amyloidosis, dysplastic changes, reduction in the amount of glycogen in hepatocytes, as well as the change in the number of Kupfer and endothelial cells. The established changes correlated with the duration of iv heroin abuse, whereas sinusoidal macrophages were activated in cases with active hepatitis, and no significant change in their number was found in hepatocytes with alcohol-related fatty changes. Conclusion. The study showed that the most present change in the hepatocytes of drug addicts was vesicular degeneration, and it is the only direct consequence of the effect of heroin. Other morphological changes were present due to viral infections and they correlated with the duration of narcotic abuse. The finding of dysplastic changes in this susceptible population of young people is particularly significant. The forensic significance of the established changes in the liver tissue is in the possibility of their practical application for determination of the immediate cause of death of iv heroin addicts, as well as the differential diagnosis of not only heroin, but also alcohol, sedative and other substances abuse, and all that on the basis of morphological damages of the liver.Uvod/Cilj. Proucavanje morfoloskih lezija jetre kod heroinomana omogucava precizno sagledavanje vrste i stepena ostecenja jetre izazvanih intravenskom (iv) zloupotrebom heroina, aditivne efekte virusnih infekcija i konzumiranja alkohola, kao i da li je izrazenost ovih lezija zavisna od duzine vremenskog perioda u kojem je dat heroin iv. Cilj ove studije bio je odredjivanje patohistoloskih, ultrastrukturnih i morfometrijskih odlika jetre hronicnih heroinomana u forenzickom uzorku jetre. Metode. Istrazivanje je obavljeno kod 40 autopsija leseva iv heroinomana i 10 kontrolnih autopsija. Studijska grupa obuhvatala je uzorke jetre 36 leseva muskog i cetiri lesa zenskog pola, starosti 15 do 40 godina, a kontrolna osam leseva muskog i dva lesa zenskog pola, starosti 15 do 35 godina. Uzorci tkiva jetre bili su pripremljeni za primenu svetlosne mikroskopije. Preseci parafinskih tkivnih blokova debljine 5 ? bili su bojeni klasicnom hematoksilin-eozin metodom (HE), PAS, Van Gieson, Gomori i Kongo crveno. Za istrazivanje ultrastrukturnih promena tkivo jetre bilo je fiksirano u glutar-aldehidu i kalupljeno u eponu. Analiza je izvrsena metodom transmisione elektronomikroskopije. Morfometrijsko ispitivanje makrofaga sinusoida jetre obavljeno je uz upotrebu test sistema M 42. Rezultati. U istrazivanoj grupi autopsijskih uzoraka jetre iv heroinomana nadjene su degenerativne- vezikularne i masne promene, hronicni hepatitis, ciroza, talozenje patoloskog proteina-amiloidoza, displasticne promene, smanjenje kolicine glikogena u hepatocitima, kao i promene broja Kupferovih i endotelnih celija. Utvrdjene promene bile su u korelaciji sa duzinom intravenske zloupotrebe heroina, dok su sinusoidalni makrofagi aktivisani u slucajevima sa aktivnim hepatitisom, a nije bilo znacajne promene njihovog broja u slucajevima sa alkoholnim masnim promenama hepatocita. Zakljucak. Ova studija pokazala je da je vezikularna degeneracija najzastupljenija promena na hepatocitima iv heroinomana i ona je jedina direktna posledica delovanja heroina. Ostale morfoloske promene nastale su delovanjem virusnih infekcija i bile su u korelaciji sa duzinom zloupotrebe narkotika. Posebno je znacajan nalaz displaznih promena u ovoj osetljivoj populaciji mladih ljudi. Forenzicki znacaj utvrdjenih promena na tkivu jetre ogleda se u mogucnosti njihove prakticne primene za utvrdjivanje neposrednog uzroka smrti iv heroinomana, kao i diferencijalne dijagnoze zloupotrebe heroina, ali i alkohola, sedativa i drugih sredstava, a na osnovu morfoloskih ostecenja u jetri.