Autopsy studies from the 1980s of several hundred patients with cardiac dysfunction9,11 demonstrated that cardiac hepatopathy manifests microscopically as sinusoidal congestion and dilation, centrilobular necrosis, centrilobular inflammation, hepatocyte atrophy, regenerative hyperplasia, and cardiac sclerosis, which was defined by Lefkowitch and Mendez9 as "fibrous tissue scars involving the walls of central veins (or their lumens) and extending for variable distances into the lobule where they filled the space of Disse and surrounded hepatocytes." Similar findings have been reported in the livers of patients with Budd-Chiari syndrome, namely sinusoidal dilation, centrilobular necrosis, and perivenular fibrosis.
Red blood cells can be seen in the space of Disse (hematoxylin-eosin, original magnification X200).
These fenestrations are clustered throughout the cytoplasm to form dynamic sieve plates and facilitate the steric transport of cargo from the lumen (sinusoidal space) to the space of Disse and into the parenchyma .
The loss in fenestration and the appearance of basement membrane in the space of Disse are observed early in a fibrotic liver, a process referred to as capillarization.
The development of capillarized sinusoids will cause a perturbation in hepatic microcirculation and compromise the exchange of materials across the endothelium and the space of Disse between the sinusoidal blood and parenchymal cells .
In areas of the parenchyma where focal perisinusoidal fibrosis developed, FVIIIRAg immunoreactive endothelial cells could be seen overlying bundles of collagen fibers in the space of Disse (Figures 3(b) and 3(c)), presumably representing a morphological link between the histogenesis of vascular endothelium and fibrogenesis of the space of Disse.
Microscopically findings were characterized by dilatation of the space of Disse by glycogen extruded from hepatocytes with endothelial rupture and subsequent erosion of the hepatocytes.
Andersen and Hart [l] proposed that hepatic telangiectasis is due to glycogen accumulation in the sub endothelial region of the sinusoid which distort and destroy the endothelium, allowing the blood to enter the space of Disse, eroding the hepatocytes.
Kupffer cells, located in the space of Disse
, tested positive for hemosiderin (iron pigments) (Lyon et al.
In addition, the livers showed severe edema accompanied by dilation of the space of Disse
, bile stasis within canaliculi and hepatocytes, and atrophy of the hepatic cords.
In normal liver, the low-density basement membrane-like matrix in the space of Disse
is mainly composed of collagens IV and VI.
The space of Disse
is localized among the LSECs and neighboring hepatocytes due to the loss of the basement membrane between the two .