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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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2
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Fatima I, Mahadevia H, Madhusudhana S, Shrestha A. Vanishing bile duct syndrome as a presentation of Hodgkin's lymphoma. BMJ Case Rep 2024; 17:e256818. [PMID: 38772873 DOI: 10.1136/bcr-2023-256818] [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] [Indexed: 05/23/2024] Open
Abstract
Vanishing bile duct syndrome is an uncommon condition characterised by the progressive loss and disappearance of bile ducts. It is an acquired form of cholestatic liver disease presenting with hepatic ductopenia (loss of >50% bile ducts in the portal areas). We present a case of vanishing bile duct syndrome as a presentation of Hodgkin's lymphoma who was treated with standard-of-care chemotherapy-doxorubicin, bleomycin, vinblastine and dacarbazine (along with brief administration of rituximab), which led to complete response and normalisation of liver function.
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Affiliation(s)
- Ifrah Fatima
- Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Himil Mahadevia
- Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Sheshadri Madhusudhana
- Medicine, Section of Hematology and Oncology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Anuj Shrestha
- Medicine, Section of Hematology and Oncology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
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3
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Fiel MI, Schiano TD. Systemic Disease and the Liver Part 2: Pregnancy-Related Liver Injury, Sepsis/Critical Illness, Hypoxia, Psoriasis, Scleroderma/Sjogren's Syndrome, Sarcoidosis, Common Variable Immune Deficiency, Cystic Fibrosis, Inflammatory Bowel Disease, and Hematologic Disorders. Surg Pathol Clin 2023; 16:485-498. [PMID: 37536884 DOI: 10.1016/j.path.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The liver is involved in many multisystem diseases and commonly may manifest with abnormal liver chemistry tests. The liver test perturbations may be multifactorial in nature, however, as patients are receiving many different medications and can also have intrinsic liver disease that may be exacerbated by the systemic disorder. Some disorders have typical histologic findings that can be diagnosed on liver biopsy, whereas others will show a more nonspecific histology. Clinicians should be aware of these conditions so as to consider the performance of a liver biopsy at the most opportune time and setting to help establish the diagnosis of acute or chronic liver disease.
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Affiliation(s)
- Maria Isabel Fiel
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA.
| | - Thomas D Schiano
- Division of Liver Diseases, Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place-Box 1104, New York, NY 10029, USA
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4
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Mellat-Ardakani M, Salahshour F, Rafsanjani K, Avanaki FA, Azizi M. Vanishing bile duct syndrome-related jaundice as the first presentation of Hodgkin lymphoma. Radiol Case Rep 2023; 18:3291-3294. [PMID: 37483375 PMCID: PMC10362112 DOI: 10.1016/j.radcr.2023.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Vanishing bile duct syndrome is a rare, acquired disease that has been described in different pathologic conditions' including adverse drug reactions, autoimmune diseases, graft vs host disease, and neoplasms. It is a condition characterized by progressive loss of intrahepatic bile ducts leading to ductopenia and cholestasis. Here we report a 27-year-old female who presented with jaundice and cholestatic hepatitis and was finally diagnosed with vanishing Bile duct syndrome secondary to Hodgkin lymphoma. Physicians need to consider a range of differential diagnoses, especially malignancies, in suspected cases of vanishing bile duct syndrome.
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Affiliation(s)
- Milad Mellat-Ardakani
- Department of Radiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - Katayoun Rafsanjani
- Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Foroogh Alborzi Avanaki
- Gastroenterology Ward, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Azizi
- Department of Pathology, Cancer Institute, Imam Khomeini hospital complex, Tehran University of Medical Sciences, Tehran, Iran
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5
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Shokri F, Shariati A, Veisari AK, Kianezhad A, Sheidaei S, Alamian AA, Sadeghi H, Heidary M. Fatal vanishing bile duct syndrome in Iranian patient with Hodgkin's lymphoma. Clin Case Rep 2023; 11:e7671. [PMID: 37484745 PMCID: PMC10357002 DOI: 10.1002/ccr3.7671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) has been postulated that may be related to Hodgkin's lymphoma (HL). In the present study, we present a 75-year-old male patient with HL who received chemotherapy but has not received any radiotherapy. The patient's condition worsened in further days, and he died with the diagnosis of cirrhosis and hepatic failure.
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Affiliation(s)
- Fazlollah Shokri
- Department of Medical Genetics, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
| | - Aref Shariati
- Molecular and Medicine Research CenterKhomein University of Medical SciencesKhomeinIran
| | - Arash Kazemi Veisari
- Department of Internal Medicine, Gut and Liver Research Center, School of MedicineMazandaran University of Medical SciencesSariIran
| | | | - Somayeh Sheidaei
- Department of Laboratory Sciences, Faculty of Paramedical SciencesMazandaran University of Medical SciencesSariIran
| | - Ali Asghar Alamian
- Department of Orthopedics, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Hossein Sadeghi
- Genomic Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical SciencesSabzevar University of Medical SciencesSabzevarIran
- Cellular and Molecular Research CenterSabzevar University of Medical SciencesSabzevarIran
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6
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Hodgkin Lymphoma-related Vanishing Bile Duct Syndrome Cholestasis Resolved After Chemotherapy. J Pediatr Hematol Oncol 2022; 44:e728-e732. [PMID: 34133379 DOI: 10.1097/mph.0000000000002223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
Vanishing bile duct syndrome is a rare paraneoplastic syndrome occasionally seen in pediatric Hodgkin lymphoma. It is usually regarded as a fatal disorder. Here, we present a case of vanishing bile duct syndrome cholestasis related to Hodgkin lymphoma that resolved after chemotherapy and radiation.
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7
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Peringeth G, Torka P, Wong J, Hernandez-Ilizaliturri FJ. Successful Treatment of Paraneoplastic Cholestasis in Relapsed/Refractory Hodgkin Lymphoma With Bridging Therapy and Checkpoint Blockade. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e316-e319. [PMID: 32179034 DOI: 10.1016/j.clml.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/05/2020] [Accepted: 01/20/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Gopisree Peringeth
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pallawi Torka
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Jerry Wong
- Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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8
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Abstract
Hepatic abnormalities in patients with lymphoproliferative disorders are common and can occur from direct infiltration by abnormal cells, bile duct obstruction, paraneoplastic syndrome, hemophagocytic syndrome, drug-induced liver injury, opportunistic infections, and reactivation of viral hepatitis. Hepatic involvement by lymphoma is often in association with systemic disease and rarely seen as a primary hepatic lymphoma. Vanishing bile duct syndrome is a well-known complication of Hodgkin disease. Antiviral prophylaxis for hepatitis B virus (HBV) reactivation is recommended for all HBsAg+ patients undergoing chemotherapy and all resolved HBV patients undergoing rituximab therapy and stem cell transplantation.
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Affiliation(s)
- Chalermrat Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand; Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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9
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Mihăilă RG. Liver Involvement in Hodgkin's Lymphoma: Types of Injuries and Therapeutic Implications. ACTA ACUST UNITED AC 2017. [DOI: 10.18052/www.scipress.com/ijppe.8.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The hepatocytolysis raises questions on following therapeutic conduct when it occurs during chemotherapy for Hodgkin's lymphoma, expression of its liver toxicity. But the onset of primary liver Hodgkin's lymphoma, including the form manifested by acute liver failure, poses even greater problems, as in the case of occurrence of vanishing bile duct syndrome - expression of a paraneoplastic syndrome, hemophagocytic lymphohistiocytosis, peliosis hepatis or association of lymphoma with infection with hepatitis viruses or human immunodeficiency virus or different autoimmune diseases. This review summarizes the clinical experience acquired on the relationship between Hodgkin's lymphoma and liver, from the point of view of clinical manifestations, used treatments and clinical evolution. Suggestions on the course of treatment in patients with Hodgkin's lymphoma and liver damage have been formulated starting from the metabolism and elimination of chemotherapy drugs and taking into account the clinical experience of published clinical trials and cases. This review is a synthesis of knowledge obtained in this field, during the time, of therapeutic possibilities and limits, and formulates potential future milestones for research.
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10
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Bakhit M, McCarty TR, Park S, Njei B, Cho M, Karagozian R, Liapakis A. Vanishing bile duct syndrome in Hodgkin’s lymphoma: A case report and literature review. World J Gastroenterol 2017; 23:366-372. [PMID: 28127210 PMCID: PMC5236516 DOI: 10.3748/wjg.v23.i2.366] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/04/2016] [Accepted: 08/05/2016] [Indexed: 02/06/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) has been described in different pathologic conditions including infection, ischemia, adverse drug reactions, autoimmune diseases, allograft rejection, and humoral factors associated with malignancy. It is an acquired condition characterized by progressive destruction and loss of the intra-hepatic bile ducts leading to cholestasis. Prognosis is variable and partially dependent upon the etiology of bile duct injury. Irreversible bile duct loss leads to significant ductopenia, biliary cirrhosis, liver failure, and death. If biliary epithelial regeneration occurs, clinical recovery may occur over a period of months to years. VBDS has been described in a number of cases of patients with Hodgkin’s lymphoma (HL) where it is thought to be a paraneoplastic phenomenon. This case describes a 25-year-old man found on liver biopsy to have VBDS. Given poor response to medical treatment, the patient underwent transplant evaluation at that time and was found to have classical stage IIB HL. Early recognition of this underlying cause or association of VBDS, including laboratory screening, and physical exam for lymphadenopathy are paramount to identifying potential underlying VBDS-associated malignancy. Here we review the literature of HL-associated VBDS and report a case of diagnosed HL with biopsy proven VBDS.
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11
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Chen F, Tu XL. Revaluation of vanishing bile duct syndrome. Shijie Huaren Xiaohua Zazhi 2016; 24:3445-3453. [DOI: 10.11569/wcjd.v24.i23.3445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) can result from multiple etiologies, including congenital and genetic diseases, ischemic causes, neoplastic disorders, infections, immune disorders, drugs, idiopathic adulthood ductopenia (IAD) and so on. Recently, lymphoma, HIV/AIDS and drugs were identified to be major etiologies in the reported cases, some of which presented complex clinical course and were contributed by more than one etiological factor. Hepatic biopsy must be done for the diagnosis of VBDS and immunohistochemical staining for cytokeratin 7 (CK7) and CK19 has contributed to the establishment of diagnosis of VBDS. VBDS can be usually treated with symptomatic and supportive therapy, etiological therapy, liver transplantation, ursodeoxycholic acid and immunosuppressive agents. Glucocorticoids can be tried to switch to mycophemolate mofeil or tacrolimus when their effects are poor or side effects are severe. Severe cases ought to receive multimodality therapy besides plasmapheresis.
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12
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Deeper Insights Into Vanishing Bile Duct Syndrome in Lymphoma: A Perplexing Entity. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e65-70. [DOI: 10.1016/j.clml.2016.02.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/18/2016] [Indexed: 01/01/2023]
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13
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Yeh P, Lokan J, Anantharajah A, Grigg A. Vanishing bile duct syndrome and immunodeficiency preceding the diagnosis of Hodgkin lymphoma. Intern Med J 2015; 44:1240-4. [PMID: 25442758 DOI: 10.1111/imj.12609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 04/21/2014] [Indexed: 11/30/2022]
Abstract
Vanishing bile duct syndrome (VBDS) in association with Hodgkin lymphoma (HL) is well described but not well understood. We report an unusual case of a 75-year-old patient presenting with biopsy-proven VBDS and immunodeficiency, without identifiable cause, which showed a waxing and waning course, culminating in the development of HL 18 months later. To our knowledge, this is the first adult case in which VBDS preceded the diagnosis of HL by such a long period.
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Affiliation(s)
- P Yeh
- Department of Haematopathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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14
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Hallén K, Sangfelt P, Nilsson T, Nordgren H, Wanders A, Molin D. Vanishing bile duct-like syndrome in a patient with Hodgkin lymphoma - pathological development and restitution. Acta Oncol 2014; 53:1271-5. [PMID: 24697745 DOI: 10.3109/0284186x.2014.897001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Rota Scalabrini D, Caravelli D, Carnevale Schianca F, D'Ambrosio L, Tolomeo F, Boccone P, Manca A, De Rosa G, Nuzzo A, Aglietta M, Grignani G. Complete remission of paraneoplastic vanishing bile duct syndrome after the successful treatment of Hodgkin's lymphoma: a case report and review of the literature. BMC Res Notes 2014; 7:529. [PMID: 25125318 PMCID: PMC4143581 DOI: 10.1186/1756-0500-7-529] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/04/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Vanishing bile duct syndrome has been associated with different pathologic conditions (adverse drug reactions, autoimmune diseases, graft versus host disease, and cancer). Though its causes are unknown, an immune-related pathogenesis is the most likely one. Vanishing bile duct syndrome can evolve to hepatic failure and, eventually, to death. The treatment is uncertain, but it needs the resolution of the underlying pathologic condition. CASE PRESENTATION We describe the association of Hodgkin's lymphoma with a syndrome characterized by cholestasis, aminotransferase elevation and an histological picture of bile duct loss. All other causes of hepatic function impairment were excluded (in particular, drugs, viral and autoimmune related diseases) eventually leading to the diagnosis of vanishing bile duct syndrome. Despite the fact that the dysfunction is not caused by hepatic Hodgkin's lymphoma involvement, liver impairment can limit the optimal therapy of Hodgkin's lymphoma. A treatment consisting of ursodeoxycholic acid, prednisone, and full dose chemotherapy restored hepatic function and achieved complete and long-lasting remission of Hodgkin's lymphoma. CONCLUSION We reviewed all case reports showing that vanishing bile duct syndrome is a dismal paraneoplastic syndrome being fatal in a high proportion of patients if not adequately treated. Indeed, this syndrome requires both an early recognition and an appropriate aggressive treatment consisting of full dose upfront chemotherapy which is the only way to achieve a resolution of the vanishing bile duct syndrome. Delayed or reduced intensity treatments unfavorably correlate with survival.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Giovanni Grignani
- Division of Oncology, Candiolo Cancer Institute, FPO, IRCCS, University of Torino Medical School, Candiolo, Italy.
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16
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Concurrent liver hodgkin lymphoma and nodular regenerative hyperplasia on an explanted liver with clinical diagnosis of alcoholic cirrhosis at university hospital fundación santa fe de bogotá. Case Rep Pathol 2014; 2014:193802. [PMID: 24511402 PMCID: PMC3912894 DOI: 10.1155/2014/193802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/11/2013] [Indexed: 11/17/2022] Open
Abstract
Liver involvement by Hodgkin lymphoma (HL) is well documented. However, secondary liver failure to this neoplastic process is rare and usually presents late in the course of the disease. We present a case of a HL associated with nodular regenerative hyperplasia (NRH) diagnosed on an explanted liver from a 53-year-old patient with clinical diagnosis of alcoholic cirrhosis. Hematoxylin and eosin stain (H&E) showed abnormal liver architecture with hepatocytes nodules highlighted by reticulin stain with absent fibrosis on the trichrome stain. The portal spaces had diffuse infiltration by Reed-Sternberg cells positive for CD15, CD30, and latent membrane protein (LMP) on immunohistochemical studies. The patient also had a concurrent hilar lymph node biopsy that also showed HL involvement. Liver failure as the initial presentation of Hodgkin' lymphoma is rare. We believe that more research about the utility of performing liver biopsies in patients candidates for transplantation with noncirrhotic hepatic failure is needed in order to establish the etiology and the optimal treatment.
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17
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Wong KM, Chang CS, Wu CC, Yin HL. Hodgkin's lymphoma-related vanishing bile duct syndrome: a case report and literature review. Kaohsiung J Med Sci 2013; 29:636-41. [PMID: 24183359 DOI: 10.1016/j.kjms.2013.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/26/2012] [Indexed: 02/07/2023] Open
Abstract
We report the case of a 38-year-old man who developed vanishing bile duct syndrome in association with Hodgkin's lymphoma. He was noted to have cervical lymphadenopathy and marked elevation of total serum bilirubin at diagnosis. He achieved complete remission with normalization of serum bilirubin after eight courses of Adriamycin, bleomycin, vinblastine, and dacarbazine chemotherapy followed with autologous hematopoietic cell transplantation. Consecutive liver biopsies performed at diagnosis and at the stage of complete remission revealed the disappearance and regeneration of interlobular bile ducts, respectively. Our case provides pathological evidence that Hodgkin's lymphoma-related vanishing bile duct syndrome is a reversible bile duct injury disease. Bilirubin is a reliable serum marker to monitor the treatment response of these cases. The mechanism to develop hyperbilirubinemia with vanishing bile duct in such a case of Hodgkin's lymphoma remains to be studied. A literature review was carried out.
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Affiliation(s)
- Kiong-Ming Wong
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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18
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Oppenheimer AP, Koh C, McLaughlin M, Williamson JC, Norton TD, Laudadio J, Heller T, Kleiner DE, High KP, Morse CG. Vanishing bile duct syndrome in human immunodeficiency virus infected adults: A report of two cases. World J Gastroenterol 2013; 19:115-21. [PMID: 23326172 PMCID: PMC3542762 DOI: 10.3748/wjg.v19.i1.115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/02/2012] [Accepted: 08/03/2012] [Indexed: 02/06/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) is a group of rare disorders characterized by ductopenia, the progressive destruction and disappearance of intrahepatic bile ducts leading to cholestasis. Described in association with medications, autoimmune disorders, cancer, transplantation, and infections, the specific mechanisms of disease are not known. To date, only 4 cases of VBDS have been reported in human immunodeficiency virus (HIV) infected patients. We report 2 additional cases of HIV-associated VBDS and review the features common to the HIV-associated cases. Presentation includes hyperbilirubinemia, normal liver imaging, and negative viral and autoimmune hepatitis studies. In HIV-infected subjects, VBDS occurred at a range of CD4+ T-cell counts, in some cases following initiation or change in antiretroviral therapy. Lymphoma was associated with two cases; nevirapine, antibiotics, and viral co-infection were suggested as etiologies in the other cases. In HIV-positive patients with progressive cholestasis, early identification of VBDS and referral for transplantation may improve outcomes.
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Aleem A, Al-Katari M, Alsaleh K, AlSwat K, Al-Sheikh A. Vanishing bile duct syndrome in a Hodgkin's lymphoma patient with fatal outcome despite lymphoma remission. Saudi J Gastroenterol 2013; 19:286-9. [PMID: 24195983 PMCID: PMC3958977 DOI: 10.4103/1319-3767.121037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Vanishing bile duct syndrome (VBDS) is a condition resulting from severe bile duct injury, progressive destruction, and disappearance of intrahepatic bile ducts (ductopenia) leading to cholestasis, biliary cirrhosis, and liver failure. VBDS can be associated with a variety of disorders, including Hodgkin's lymphoma (HL). We describe a 33-year-old male patient who presented with lymphadenopathy and jaundice, and was diagnosed to have HL. Serum bilirubin worsened progressively despite chemotherapy, with a cholestatic pattern of liver enzymes. Diagnosis of VBDS was established on liver biopsy. Although remission from HL was achieved, the patient died of liver failure. Presence of jaundice in HL patients should raise the possibility of VBDS. This report discusses the difficulties of delivering chemotherapy in patients with liver dysfunction. HL-associated VBDS carries a high mortality but lymphoma remission can be achieved in some patients. Therefore, liver transplantation should be considered early in these patients.
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Affiliation(s)
- Aamer Aleem
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Address for correspondence: Dr. Aamer Aleem, Consultant Hematologist, Department of Medicine (38), King Khalid University Hospital, Riyadh 11472, Saudi Arabia. E-mail:
| | - Mohammad Al-Katari
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Alsaleh
- Department of Medicine, Division of Hematology/Oncology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khalid AlSwat
- Department of Gastroenterology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmalik Al-Sheikh
- Department of Pathology, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Mutation of zebrafish Snapc4 is associated with loss of the intrahepatic biliary network. Dev Biol 2011; 363:128-37. [PMID: 22222761 DOI: 10.1016/j.ydbio.2011.12.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 12/13/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022]
Abstract
Biliary epithelial cells line the intrahepatic biliary network, a complex three-dimensional network of conduits. The loss of differentiated biliary epithelial cells is the primary cause of many congenital liver diseases. We identified a zebrafish snapc4 (small nuclear RNA-activating complex polypeptide 4) mutant in which biliary epithelial cells initially differentiate but subsequently disappear. In these snapc4 mutant larvae, biliary epithelial cells undergo apoptosis, leading to degeneration of the intrahepatic biliary network. Consequently, in snapc4 mutant larvae, biliary transport of ingested fluorescent lipids to the gallbladder is blocked. Snapc4 is the largest subunit of a protein complex that regulates small nuclear RNA (snRNA) transcription. The snapc4(s445) mutation causes a truncation of the C-terminus, thereby deleting the domain responsible for a specific interaction with Snapc2, a vertebrate specific subunit of the SNAP complex. This mutation leads to a hypomorphic phenotype, as only a subset of snRNA transcripts are quantitatively altered in snapc4(s445) mutant larvae. snapc2 knockdown also disrupts the intrahepatic biliary network in a similar fashion as in snapc4(s445) mutant larvae. These data indicate that the physical interaction between Snapc2 and Snapc4 is important for the expression of a subset of snRNAs and biliary epithelial cell survival in zebrafish.
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