Limits...
Sinusoidal obstruction syndrome after oxaliplatin-based chemotherapy.

Seo AN, Kim H - Clin Mol Hepatol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

A 58-year-old Korean woman presented with hematochezia during 2 months in June, 2011. She had no significant past medical history and also denied any previous intake of alcohol, smoking and herbal agents. The initial computed tomography (CT) scan demonstrated two masses in the rectum and ascending colon, multiple enlarged regional lymph nodes, two metastatic nodules in segments 6 and 8 of the liver and also pulmonary metastasis. She was treated with 6 cycles of XELOX (oral capecitabine [1,000 mg/m2 twice daily on days 1 to 14] plus oxaliplatin [130 mg/m2 on day 1]) over a 5-month period. A follow-up CT scan at 5 months after chemotherapy revealed a partial tumor response, and after one month, she underwent low anterior resection of the rectum, right hemihepatectomy of the liver, and left lobectomy of the lung. Preoperative liver function tests were within normal limits: aspartate aminotransferase (AST) 24 IU/L, alanine aminotransferase (ALT) 12 IU/L, alkaline phosphatase (ALP) 60 IU/L, total bilirubin 0.8 mg/dL, and prothrombin time (PT) 1.07 INR. Serologic tests for hepatitis B and hepatitis C virus were negative.

Show MeSH

Related in: MedlinePlus

Representative microscopic findings of sinusoidal obstruction syndrome (A-D). Patchy perivenular sinusoidal dilatation and congestion with hepatocyte plate disruption (A ×100 magnification). Approximation of portal structures and hepatic vein with loss of intervening hepatocytes, and perivenular and perisinusoidal fibrosis (B ×100 magnification, Masson's trichrome stain). Sinusoidal dilatation and congestion with atrophy and disruption of hepatocyte plates (C ×200 magnification). An obliterated terminal hepatic venule is seen in the center (arrow). Masson's trichrome stain demonstrating fibrous obliteration of a terminal hepatic venule (D ×400 magnification).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3992335&req=5

Figure 2: Representative microscopic findings of sinusoidal obstruction syndrome (A-D). Patchy perivenular sinusoidal dilatation and congestion with hepatocyte plate disruption (A ×100 magnification). Approximation of portal structures and hepatic vein with loss of intervening hepatocytes, and perivenular and perisinusoidal fibrosis (B ×100 magnification, Masson's trichrome stain). Sinusoidal dilatation and congestion with atrophy and disruption of hepatocyte plates (C ×200 magnification). An obliterated terminal hepatic venule is seen in the center (arrow). Masson's trichrome stain demonstrating fibrous obliteration of a terminal hepatic venule (D ×400 magnification).

Mentions: On gross examination, the resected liver showed 2 yellowish-white nodules corresponding to the metastatic lesions, and the background liver showed a distinct mottled appearance, with areas of congestion alternating with relatively normal-appearing hepatic parenchyme (Fig. 1). Microscopically, the nodules were consistent with metastatic adenocarcinomas from the colorectum. The non-tumorous liver parenchyme showed diffuse sinusoidal dilatation and congestion with extravasation of red blood cells, which predominantly affected the centrilobular zones. Hepatocytic plate disruption was seen in areas of severe sinusoidal congestion, and parenchymal extinction lesions (PELs) - defined as the approximation of hepatic vein remnants and portal tracts with loss of intervening hepatocytes - were noted. Masson's trichrome stain high-lighted centrilobular venular fibrosis and perisinusoidal fibrosis, and fibrous occlusion of small terminal hepatic venules was seen (Fig. 2). Macrovesicular and microvesicular steatosis was seen in less than 33% of hepatocytes. Hepatocellular ballooning was not prominent, and there was no significant lobular or portal inflammation. There was no significant cholestasis or ductular reaction.


Sinusoidal obstruction syndrome after oxaliplatin-based chemotherapy.

Seo AN, Kim H - Clin Mol Hepatol (2014)

Representative microscopic findings of sinusoidal obstruction syndrome (A-D). Patchy perivenular sinusoidal dilatation and congestion with hepatocyte plate disruption (A ×100 magnification). Approximation of portal structures and hepatic vein with loss of intervening hepatocytes, and perivenular and perisinusoidal fibrosis (B ×100 magnification, Masson's trichrome stain). Sinusoidal dilatation and congestion with atrophy and disruption of hepatocyte plates (C ×200 magnification). An obliterated terminal hepatic venule is seen in the center (arrow). Masson's trichrome stain demonstrating fibrous obliteration of a terminal hepatic venule (D ×400 magnification).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3992335&req=5

Figure 2: Representative microscopic findings of sinusoidal obstruction syndrome (A-D). Patchy perivenular sinusoidal dilatation and congestion with hepatocyte plate disruption (A ×100 magnification). Approximation of portal structures and hepatic vein with loss of intervening hepatocytes, and perivenular and perisinusoidal fibrosis (B ×100 magnification, Masson's trichrome stain). Sinusoidal dilatation and congestion with atrophy and disruption of hepatocyte plates (C ×200 magnification). An obliterated terminal hepatic venule is seen in the center (arrow). Masson's trichrome stain demonstrating fibrous obliteration of a terminal hepatic venule (D ×400 magnification).
Mentions: On gross examination, the resected liver showed 2 yellowish-white nodules corresponding to the metastatic lesions, and the background liver showed a distinct mottled appearance, with areas of congestion alternating with relatively normal-appearing hepatic parenchyme (Fig. 1). Microscopically, the nodules were consistent with metastatic adenocarcinomas from the colorectum. The non-tumorous liver parenchyme showed diffuse sinusoidal dilatation and congestion with extravasation of red blood cells, which predominantly affected the centrilobular zones. Hepatocytic plate disruption was seen in areas of severe sinusoidal congestion, and parenchymal extinction lesions (PELs) - defined as the approximation of hepatic vein remnants and portal tracts with loss of intervening hepatocytes - were noted. Masson's trichrome stain high-lighted centrilobular venular fibrosis and perisinusoidal fibrosis, and fibrous occlusion of small terminal hepatic venules was seen (Fig. 2). Macrovesicular and microvesicular steatosis was seen in less than 33% of hepatocytes. Hepatocellular ballooning was not prominent, and there was no significant lobular or portal inflammation. There was no significant cholestasis or ductular reaction.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.

ABSTRACT

A 58-year-old Korean woman presented with hematochezia during 2 months in June, 2011. She had no significant past medical history and also denied any previous intake of alcohol, smoking and herbal agents. The initial computed tomography (CT) scan demonstrated two masses in the rectum and ascending colon, multiple enlarged regional lymph nodes, two metastatic nodules in segments 6 and 8 of the liver and also pulmonary metastasis. She was treated with 6 cycles of XELOX (oral capecitabine [1,000 mg/m2 twice daily on days 1 to 14] plus oxaliplatin [130 mg/m2 on day 1]) over a 5-month period. A follow-up CT scan at 5 months after chemotherapy revealed a partial tumor response, and after one month, she underwent low anterior resection of the rectum, right hemihepatectomy of the liver, and left lobectomy of the lung. Preoperative liver function tests were within normal limits: aspartate aminotransferase (AST) 24 IU/L, alanine aminotransferase (ALT) 12 IU/L, alkaline phosphatase (ALP) 60 IU/L, total bilirubin 0.8 mg/dL, and prothrombin time (PT) 1.07 INR. Serologic tests for hepatitis B and hepatitis C virus were negative.

Show MeSH
Related in: MedlinePlus