1
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Miyazawa M, Yanagi M, Chiba T, Kido H, Matsuo T, Nishitani M, Orita N, Takata N, Hayashi T, Seki A, Nakagawa H, Nio K, Terashima T, Iida N, Yamada S, Takatori H, Shimakami T, Arai K, Yamashita T, Mizukoshi E, Honda M, Yamashita T. Post-allogeneic Hematopoietic Stem Cell Transplantation Portal Hypertension Not Associated with Liver Cirrhosis, Veno-occlusive Disease, or Graft-versus-host Disease. Intern Med 2024; 63:1563-1568. [PMID: 37839881 PMCID: PMC11189707 DOI: 10.2169/internalmedicine.2489-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023] Open
Abstract
We herein report a rare case of idiopathic portal hypertension (IPH)-like disease that developed after allogeneic hematopoietic stem cell transplantation (allo-HSCT). A 53-year-old woman who underwent allo-HSCT for acute myeloid leukemia showed portal hypertension with radiological and histopathological findings consistent with IPH, distinct from veno-occlusive disease (VOD) and graft-versus-host disease (GVHD) of the liver. This case highlights the importance of considering IPH-like disease as a potential cause of portal hypertension after allo-HSCT. Awareness of this complication can aid in the early diagnosis and appropriate management of patients post allo-HSCT.
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Affiliation(s)
- Masaki Miyazawa
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Masahiro Yanagi
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Tomoyoshi Chiba
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Hidenori Kido
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Toshiki Matsuo
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Masaki Nishitani
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Noriaki Orita
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Noboru Takata
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Tomoyuki Hayashi
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Akihiro Seki
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | | | - Kouki Nio
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | | | - Noriho Iida
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Shinya Yamada
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Hajime Takatori
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | | | - Kuniaki Arai
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | | | | | - Masao Honda
- Department of Gastroenterology, Kanazawa University Hospital, Japan
| | - Taro Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, Japan
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2
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Nunzi A, Ciangola G, Cerroni I, Mezzanotte V, Trotta GE, Meconi F, Zizzari A, Rapisarda VM, Savino L, Brega A, Argirò R, De Angelis G, Mariotti B, Bonanni F, Meddi E, Gurnari C, Bruno A, Mangione I, Venditti A, Cerretti R. Overlapping features of hepatic complications after hematopoietic cell transplantation in a rare T-cell lymphoma: A clinical challenge. Curr Res Transl Med 2024; 72:103436. [PMID: 38277899 DOI: 10.1016/j.retram.2023.103436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024]
Abstract
We present the case of a young adult, who developed several hepatic post-HCT complications, which made differential diagnosis extremely difficult.
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Affiliation(s)
- Andrea Nunzi
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Giulia Ciangola
- Unità Trapianto di Cellule Staminali Ematopoietiche, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia.
| | - Ilaria Cerroni
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Valeria Mezzanotte
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Gentiana Elena Trotta
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Federico Meconi
- Unità Patologie Linfoproliferative, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Annagiulia Zizzari
- Unità Patologie Linfoproliferative, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Vito Mario Rapisarda
- Unità Patologie Linfoproliferative, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Luca Savino
- Unità Anatomia Patologica, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Arianna Brega
- Unità Epatologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Renato Argirò
- Unità Radiologia Interventistica, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Gottardo De Angelis
- Unità Trapianto di Cellule Staminali Ematopoietiche, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Benedetta Mariotti
- Unità Trapianto di Cellule Staminali Ematopoietiche, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Fabrizio Bonanni
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Elisa Meddi
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Carmelo Gurnari
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia; Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Antoine Bruno
- Unità Trapianto di Cellule Staminali Ematopoietiche, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Ilaria Mangione
- Unità Trapianto di Cellule Staminali Ematopoietiche, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Adriano Venditti
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
| | - Raffaella Cerretti
- Unità Trapianto di Cellule Staminali Ematopoietiche, Dipartimento di Oncoematologia, Fondazione Policlinico di Tor Vergata, Viale Oxford 81, 00133, Roma, Italia
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Stueck AE, Fiel MI. Hepatic graft-versus-host disease: what we know, when to biopsy, and how to diagnose. Hum Pathol 2023; 141:170-182. [PMID: 37541449 DOI: 10.1016/j.humpath.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/19/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Graft-versus-host disease (GVHD) is one of the serious complications that may develop after hematopoietic cell transplantation (HCT), for hematologic malignancies, solid organ transplantation, and other hematologic disorders. GVHD develops due to T lymphocytes present in the graft attacking the host antigens, which results in tissue damage. A significant number of HCT patients develop acute or chronic GVHD, which may affect multiple organs including the liver. The diagnosis of hepatic GVHD (hGVHD) is challenging as many other conditions in HCT patients may lead to liver dysfunction. Particularly challenging among the various conditions that give rise to liver dysfunction is differentiating sinusoidal obstruction syndrome and drug-induced liver injury (DILI) from hGVHD on clinical grounds and laboratory tests. Despite the minimal risks involved in performing a liver biopsy, the information gleaned from the histopathologic changes may help in the management of these very complex patients. There is a spectrum of histologic features found in hGVHD, and most involve histopathologic changes affecting the interlobular bile ducts. These include nuclear and cytoplasmic abnormalities including dysmorphic bile ducts, apoptosis, and cholangiocyte necrosis, among others. The hepatitic form of hGVHD typically shows severe acute hepatitis. With chronic hGVHD, there is progressive bile duct loss and eventually fibrosis. Accurate diagnosis of hGVHD is paramount so that timely treatment and management can be initiated. Techniques to prevent and lower the risk of GVHD from developing have recently evolved. If a diagnosis of acute GVHD is made, the first-line of treatment is steroids. Recurrence is common and steroid resistance or dependency is not unusual in this setting. Second-line therapies differ among institutions and have not been uniformly established. The development of GVHD, particularly hGVHD, is associated with increased morbidity and mortality.
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Affiliation(s)
- Ashley E Stueck
- Department of Pathology, Dalhousie University, 715 - 5788 University Avenue, Halifax, NS, B3H 2Y9, Canada.
| | - M Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA.
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Liang TZ, Dong S, Fang M, Gong Y, Yaghmour G, Chopra S. Hepatitic Variant of Graft-vs-Host Disease. Am J Clin Pathol 2022; 157:948-955. [PMID: 35038720 DOI: 10.1093/ajcp/aqab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/30/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Graft-vs-host disease (GVHD) of the liver is a complication of allogeneic hematopoietic stem cell transplantation with hepatitic and classic variants. We determined the percentage of hepatitic variant cases, compared clinicopathologic features of the two groups, and assessed prognostic factors. METHODS Fifty liver biopsy specimens from 40 patients with GVHD were studied. RESULTS Fifteen (30%) cases had moderate to marked lobular inflammation and were classified as a hepatitic variant. Bile duct damage was present in all cases. Ductular reaction, apoptosis. and endotheliitis were more commonly seen in the hepatitic variant. Hepatocyte ballooning was an independent poor prognostic factor. The median aspartate aminotransferase and alanine aminotransferase were higher in the hepatitic variant while alkaline phosphatase and bilirubin were higher in the classic group. Forty (80%) GVHD cases were more than 100 days after transplant, correlating to immunosuppression taper. There was response to treatment with increased immunosuppression in both groups, but time to normalization of liver function tests was higher in the hepatitic variant. CONCLUSIONS Bile duct damage was the most consistent pathologic finding in our cohort and was present in all cases of GVHD. Moderate to marked lobular inflammation can be seen in GVHD in up to 30% of cases without any other coexisting cause. Hepatocyte ballooning is an independent poor prognostic factor.
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Affiliation(s)
- Tom Z Liang
- Department of Pathology, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
| | - Stephen Dong
- Department of Medicine, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
| | - Mike Fang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Yuna Gong
- Department of Pathology, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
| | - George Yaghmour
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine , Cleveland, OH , USA
| | - Shefali Chopra
- Department of Pathology, Keck Medical Center, University of Southern California , Los Angeles, CA , USA
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Citarella F, Vespasiani-Gentilucci U, Crescenzi A, Bianchi A, Virzì V, Tonini G. Liver involvement in the course of thymoma-associated multiorgan autoimmunity: The first histological description. Hepatobiliary Pancreat Dis Int 2022; 21:86-89. [PMID: 33637455 DOI: 10.1016/j.hbpd.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/19/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Fabrizio Citarella
- Department of Medical Oncology, Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, Rome 00128, Italy.
| | - Umberto Vespasiani-Gentilucci
- Area of Internal Medicine, Unit of Hepatology, Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, Rome 00128, Italy
| | - Anna Crescenzi
- Unit of Pathology, Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, Rome 00128, Italy
| | - Antonella Bianchi
- Unit of Pathology, Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, Rome 00128, Italy
| | - Vladimir Virzì
- Department of Medical Oncology, Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, Rome 00128, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo, Rome 00128, Italy
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Zhu S, Shi P, Lv C, Li H, Pan B, Chen W, Zhao K, Yan Z, Chen C, Loake GJ, Niu M, Zeng L, Xu K. Loss of NLRP3 Function Alleviates Murine Hepatic Graft-versus-Host Disease. Biol Blood Marrow Transplant 2018; 24:2409-2417. [PMID: 30053645 DOI: 10.1016/j.bbmt.2018.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/16/2018] [Indexed: 02/07/2023]
Abstract
NLRP3 is associated with multiple risks in graft-versus-host disease, though unifying principles for these findings remain largely unknown. To explore the effects and mechanisms of the absence of NLRP3 function on hepatic graft-versus-host-disease, we established an allogeneic hematopoietic cell transplantation mice model by infusing bone marrow mononuclear cells and spleno-T cells of the BALB/c mouse into either NLRP3 knockout (NLRP3-/- ) or wild-type C57BL/6 mice. Elevated inflammatory cell infiltration, liver fibrosis, and secretions of alanine aminotransferase (ALT) and aspartate transaminase (AST), together with weight loss, were observed in C57BL/6 recipients after transplantation. However, moderate injury pathology was detected in the liver of NLRP3-/- recipients at day 14, which gradually improved over time. Likewise, proinflammatory cytokine IL-1β, a downstream effecter of NLRP3 inflammasome activation, showed significantly lower expression (P < .05) in the liver of NLRP3-/- recipients relative to C57BL/6 recipients at day 7 and day 21. Moreover, compared with C57BL/6 recipients, the expression of both TNF-α and IL-1β were decreased 3-fold and 4.7-fold, respectively, at day 21 in NLRP3-/- recipients. Interestingly, NLRP1a was expressed at a significantly reduced level in the liver of NLRP3-/- recipients (P < .001). Furthermore, systemic inflammation was analyzed by measuring the concentration of IL-1β and adenosine triphosphate (ATP) in serum. The concentration of IL-1β achieved a maximum at day 14, then decreased at day 21 and day 28 in NLRP3-/- recipients. In contrast, the concentration of IL-1β in C57BL/6 recipients gradually increased from day 7 to day 28. ATP levels reduced from day 7 to day 28 in NLRP3-/- recipients, but were extremely high in C57BL/6 recipients from day 14 to day 28 (P < .01). The decreased levels of P2X7R were connected to less ATP in NLRP3-/- recipients at day 21 and day 28. In conclusion, NLRP3 knockout in recipients could significantly relieve liver injury after transplantation and block the NLRP3 inflammasome pathway, thus providing a promising strategy for the treatment of graft-versus-host disease prophylaxis.
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Affiliation(s)
- Shengyun Zhu
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Peipei Shi
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China
| | - Chaoran Lv
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China
| | - Huiqi Li
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China
| | - Bin Pan
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wei Chen
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kai Zhao
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhiling Yan
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chong Chen
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Gary J Loake
- Institute of Molecular Plant Sciences, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mingshan Niu
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lingyu Zeng
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kailin Xu
- Institute of Blood Diseases, Xuzhou Medical University, Xuzhou, China; Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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