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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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2
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Sebastian K, Smedley RC, Bartel A, Kiupel M. Patterns of Lymphocytic Infiltrates Can Differentiate Feline Hepatic Lymphoma from Lymphocytic Portal Hepatitis. Vet Sci 2023; 10:vetsci10020127. [PMID: 36851431 PMCID: PMC9960306 DOI: 10.3390/vetsci10020127] [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: 12/21/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Hepatic lymphoma is poorly characterized in cats and differentiating between inflammation and lymphomas is often difficult. The diagnosis of hepatic lymphoma in humans relies on recognition of specific patterns of lymphocytic infiltrates and clonality testing of antigen receptors. Herein, we defined similar patterns of lymphocytic infiltrates in hepatic biopsies of cats and correlated them with clonality to determine which patterns are predictive of lymphoma. A retrospective study was performed on surgical biopsies from 44 cats. The immunophenotype was characterized using CD3 and CD20 on all 44 samples. All 44 samples were tested using PCR for T-cell receptor gamma-gene rearrangements. PCR for immunoglobulin heavy chain gene rearrangements was performed on 24 of these cats. Four patterns of lymphocytic infiltrates were characterized: (1) tightly periportal, (2) periportal and centrilobular, (3) nodular, and (4) periportal with sinusoidal extension. Other histomorphologic features (fibrosis, biliary hyperplasia, bile ductopenia, bile duct targeting, hepatic hematopoiesis, lipogranulomas, lymphonodular aggregates, other inflammatory cells) were also evaluated. The sensitivity and specificity of the lymphocytic patterns to diagnose lymphomas were determined using Bayesian Hui-Walter analysis (BLCM) against clonality results. Lymphocytic patterns 2, 3, and 4 accurately diagnosed hepatic lymphomas with a sensitivity and specificity of 82% (CI 95%: 0.65, 0.96) and 77% (CI 95%: 0.54, 1.00), respectively. None of the other microscopic features evaluated were predictive of a lymphoma or inflammation. Our study identified specific patterns of lymphocytic infiltration that differentiate feline hepatic lymphoma from inflammation while other histologic features were not associated with an accurate diagnosis.
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Affiliation(s)
- Kimberley Sebastian
- Veterinary Diagnostic Laboratory, Michigan State University, Lansing, MI 48910, USA
| | - Rebecca C. Smedley
- Veterinary Diagnostic Laboratory, Michigan State University, Lansing, MI 48910, USA
| | - Alexander Bartel
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, 14163 Berlin, Germany
| | - Matti Kiupel
- Veterinary Diagnostic Laboratory, Michigan State University, Lansing, MI 48910, USA
- Correspondence:
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3
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Markedly Elevated Aspartate Aminotransferase from Non-Hepatic Causes. J Clin Med 2022; 12:jcm12010310. [PMID: 36615110 PMCID: PMC9821092 DOI: 10.3390/jcm12010310] [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: 12/05/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
There have been no reports on mortality in patients with markedly elevated aspartate aminotransferase (AST) levels from non-hepatic causes to date. This study aimed to determine the etiologies of markedly elevated AST levels > 400 U/L due to non-hepatic causes and to investigate the factors associated with mortality in these cases. This retrospective study included 430 patients with AST levels > 400 U/L unrelated to liver disease at two centers between January 2010 and December 2021. Patients were classified into three groups according to etiology: skeletal muscle damage, cardiac muscle damage, and hematologic disorder. Binary logistic regression analysis was performed to evaluate the factors associated with 30-day mortality. The most common etiology for markedly elevated AST levels was skeletal muscle damage (54.2%), followed by cardiac muscle damage (39.1%) and hematologic disorder (6.7%). The 30-day mortality rates for the skeletal muscle damage, cardiac muscle damage, and hematologic disorder groups were 14.2%, 19.5%, and 65.5%, respectively. The magnitude of the peak AST level significantly correlated with 30-day mortality, with rates of 12.8%, 26.7%, and 50.0% for peak AST levels < 1000 U/L, <3000 U/L, and ≥3000 U/L, respectively. In the multivariate analysis, cardiac muscle damage (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.31−5.80), hematologic disorder (OR = 9.47, 95% CI = 2.95−30.39), peak AST < 3000 U/L (OR = 2.94, 95% CI = 1.36−6.35), and peak AST ≥ 3000 U/L (OR = 9.61, 95% CI = 3.54−26.08) were associated with increased 30-day mortality. Our study revealed three etiologies of markedly elevated AST unrelated to liver disease and showed that etiology and peak AST level significantly affected the survival rate.
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4
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Second malignant neoplasms in lymphomas, secondary lymphomas and lymphomas in metabolic disorders/diseases. Cell Biosci 2022; 12:30. [PMID: 35279210 PMCID: PMC8917635 DOI: 10.1186/s13578-022-00763-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Abstract
With inconsistent findings, evidence has been obtained in recent years that metabolic disorders are closely associated with the development of lymphomas. Studies and multiple analyses have been published also indicating that some solid tumor survivors develop a secondary lymphoma, whereas some lymphoma survivors subsequently develop a second malignant neoplasm (SMN), particularly solid tumors. An interaction between the multiple etiologic factors such as genetic factors and late effects of cancer therapy may play an important role contributing to the carcinogenesis in patients with metabolic diseases or with a primary cancer. In this review, we summarize the current knowledge of the multiple etiologic factors for lymphomagenesis, focusing on the SMN in lymphoma, secondary lymphomas in primary cancers, and the lymphomas associated to metabolic disorders/diseases, which have been received less attention previously. Further, we also review the data of coexistence of lymphomas and hepatocellular carcinoma (HCC) in patients with infection of hepatitis C virus and hepatitis B virus.
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5
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Devarapalli UV, Sarma MS, Mathiyazhagan G. Gut and liver involvement in pediatric hematolymphoid malignancies. World J Gastrointest Oncol 2022; 14:587-606. [PMID: 35321282 PMCID: PMC8919016 DOI: 10.4251/wjgo.v14.i3.587] [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] [Received: 09/03/2021] [Revised: 10/22/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Hematolymphoid malignancies are common neoplasms in childhood. The involvement of the gastrointestinal (GI) tract, liver, biliary system, pancreas, and peritoneum are closely interlinked and commonly encountered. In leukemias, lymphomas, and Langerhans cell histiocytosis (LCH), the manifestations result from infiltration, compression, overwhelmed immune system, and chemotherapy-induced drug toxicities. In acute leukemias, major manifestations are infiltrative hepatitis, drug induced gastritis, neutropenic typhlitis and chemotherapy related pancreatitis. Chronic leukemias are rare. Additional presentation in lymphomas is cholestasis due to infiltration or biliary obstruction by lymph nodal masses. Presence of ascites needs a thorough workup for the underlying pathophysiology that may modify the therapy and affect the outcome. Uncommon hematolymphoid malignancies are primary hepatic, hepatosplenic, and GI lymphomas which have strict definitions. In advanced diseases with extensive spread, it may be impossible to distinguish these diseases from the primary site of origin. LCH produces biliary strictures that mimic as sclerosing cholangitis. Liver infiltration is associated with poor liver recovery even after chemotherapy. The heterogeneity of gut and liver manifestations in hematolymphoid malignancies has a clinical impact on their management. Though chemotherapy is the mainstay of therapy in all hematolymphoid malignancies, debulking surgery and radiotherapy have an adjuvant role in specific clinical scenarios. Rare situations presenting as liver failure or end-stage liver disease require liver transplantation. At their initial presentation to a primary care physician, given the ambiguity in clinical manifestations and the prognostic difference with time-bound management, it is vital to recognize them early for optimal outcomes. Pooled data from robust registries across the world is required for better understanding of these complications.
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Affiliation(s)
- Umeshreddy V Devarapalli
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Moinak S Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Gopinathan Mathiyazhagan
- Department of Hematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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6
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Grewe S, Shahid M, Zhang L, Jiang K. Clinically unsuspected primary hepatic mucosa-associated lymphoid tissue lymphoma collision with an intrahepatic cholangiocarcinoma: A case report and literature review. SAGE Open Med Case Rep 2021; 9:2050313X211041838. [PMID: 34457305 PMCID: PMC8392794 DOI: 10.1177/2050313x211041838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/06/2021] [Indexed: 01/03/2023] Open
Abstract
A synchronous tumor represents two histologically distinct neoplasms occurring at the same anatomic site, each displaying a distinct tumorigenesis pathway; they can be primary, secondary, or a mixture. The occurrence of an adenocarcinoma and lymphoma has been reported in gastrointestinal and pulmonary sites; however, such a finding in hepatobiliary system remains elusive. Primary hepatic lymphoma is rare, while primary biliary mucosa-associated lymphoid tissue lymphoma is an even rarer event; hence, its collision with an intrahepatic cholangiocarcinoma could be entirely missed both in practice and in the literature. We herein reported a case of biliary mucosa-associated lymphoid tissue lymphoma occurring synchronously with an intrahepatic cholangiocarcinoma in a 78-year-old female following a biopsy-proven intrahepatic cholangiocarcinoma and hepatectomy. Microscopic examination identified atypical lymphoid population intermingled with this intrahepatic cholangiocarcinoma. An immunohistochemical panel uncovered an incidental mucosa-associated lymphoid tissue lymphoma occurring with this intrahepatic cholangiocarcinoma. This clinically missed entity led to comprehensive systemic investigation/staging, with subsequent detection of bone marrow involvement by stage IV lymphoma. This unique case highlights the importance of astute histomorphological evaluation and thorough ancillary studies in identifying a clinically unsuspected neoplasm in close contact with a known tumor.
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Affiliation(s)
| | | | | | - Kun Jiang
- Moffitt Cancer Center, Tampa, FL, USA
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7
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Xu Z, Pang C, Sui J, Gao Z. A case of primary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphoma treated by radiofrequency ablation (RFA), and a literature review. J Int Med Res 2021; 49:300060521999539. [PMID: 33730924 PMCID: PMC8166399 DOI: 10.1177/0300060521999539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare liver malignancy that usually lacks characteristic imaging findings and which is often misdiagnosed. We report a 63-year-old woman diagnosed with primary hepatic extranodal marginal zone B-cell lymphoma, MALT type. The patient underwent needle biopsy and radiofrequency ablation (RFA), and showed no signs of relapse during the 12-month postoperative follow-up. This case stresses the rarity of primary hepatic MALT-type lymphoma and the unique and effective treatment for this patient. Our patient received RFA, which showed good efficacy and which provides a new option for the treatment of hepatic MALT lymphoma. We also present our findings from a systematic review to improve the current understanding of this disease.
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Affiliation(s)
- Zhe Xu
- First Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Chong Pang
- First Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jidong Sui
- First Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Dalian Medical University, Dalian, China
| | - Zhenming Gao
- First Department of Hepatobiliary and Pancreatic Surgery, The Second Hospital of Dalian Medical University, Dalian, China
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8
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Tanaka T, Saito K, Yunaiyama D, Matsubayashi J, Nagakawa Y, Tanigawa M, Nagao T. Diffusion-weighted imaging might be useful for reactive lymphoid hyperplasia diagnosis of the liver: A case report. World J Clin Cases 2020; 8:5313-5319. [PMID: 33269264 PMCID: PMC7674723 DOI: 10.12998/wjcc.v8.i21.5313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/22/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Reactive lymphoid hyperplasia (RLH) of the liver is a rare liver lesion. It is considered difficult to differentiate radiologically from hepatocellular carcinoma, metastatic liver tumor and other pathologies.
CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver. The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy. However, histopathological analysis revealed RLH. The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging. On diffusion-weighted imaging (DWI), we encountered linear hyperintensity along the portal tract consecutive to the liver lesion, which is a new characteristic radiologic finding. This finding corresponded to the lymphoid cell infiltration of the portal tract. Furthermore, there was strongly restricted diffusion on the apparent diffusion coefficient map. We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.
CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.
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Affiliation(s)
- Taro Tanaka
- Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 1600023, Japan
| | - Maki Tanigawa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo 1600023, Japan
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9
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Choi S, Kim JH, Kim K, Kim M, Choi HJ, Kim YM, Suh JH, Seo MJ, Cha HJ. Primary hepatic extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. J Pathol Transl Med 2020; 54:340-345. [PMID: 32702946 PMCID: PMC7385263 DOI: 10.4132/jptm.2020.03.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/17/2020] [Indexed: 11/17/2022] Open
Abstract
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), is one of the specific type of low-grade B-cell lymphoma not infrequently found worldwide. It typically involves mucosal sites such as stomach and conjunctiva; however, primary hepatic MALT lymphoma has been extremely rarely reported. We describe a case of hepatic MALT lymphoma in a 70-year-old male patient who underwent left hepatectomy due to the incidentally detected liver masses at a medical checkup. The resected specimen revealed multinodular masses consisting of small-to-intermediate-sized lymphoid cells with serpentine pattern and focal lymphoepithelial lesions. The tumor cells were diffusely positive for CD20 and Bcl-2 but negative for CD3, CD10, CD5, CD23, CD43, and cyclinD1. The Ki-67 labeling index was 10% and immunoglobulin heavy chain gene rearrangement study confirmed monoclonal proliferation. In this paper, we discuss several unique clinicopathologic characteristics which will be helpful to the differential diagnosis of hepatic MALT lymphoma.
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Affiliation(s)
- Soyeon Choi
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
| | - Ji Hye Kim
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
| | - Kyungbin Kim
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
| | - Misung Kim
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
| | - Hye Jeong Choi
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
- Department of Pathology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Min Kim
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
- Department of Pathology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jae Hee Suh
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
- Department of Pathology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min Jung Seo
- Department of Pathology, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Nuclear Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Hee Jeong Cha
- Department of Pathology, Ulsan University Hospital, Ulsan, Korea
- Department of Pathology, University of Ulsan College of Medicine, Ulsan, Korea
- Corresponding Author: Hee Jeong Cha, MD, Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan 44033, Korea Tel: +82-52-250-7261, Fax: +82-52-252-3024, E-mail:
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10
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Kuczynski EA, Vermeulen PB, Pezzella F, Kerbel RS, Reynolds AR. Vessel co-option in cancer. Nat Rev Clin Oncol 2019; 16:469-493. [PMID: 30816337 DOI: 10.1038/s41571-019-0181-9] [Citation(s) in RCA: 262] [Impact Index Per Article: 52.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
All solid tumours require a vascular supply in order to progress. Although the ability to induce angiogenesis (new blood vessel growth) has long been regarded as essential to this purpose, thus far, anti-angiogenic therapies have shown only modest efficacy in patients. Importantly, overshadowed by the literature on tumour angiogenesis is a long-standing, but continually emerging, body of research indicating that tumours can grow instead by hijacking pre-existing blood vessels of the surrounding nonmalignant tissue. This process, termed vessel co-option, is a frequently overlooked mechanism of tumour vascularization that can influence disease progression, metastasis and response to treatment. In this Review, we describe the evidence that tumours located at numerous anatomical sites can exploit vessel co-option. We also discuss the proposed molecular mechanisms involved and the multifaceted implications of vessel co-option for patient outcomes.
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Affiliation(s)
- Elizabeth A Kuczynski
- Bioscience, Oncology, IMED Biotech Unit, AstraZeneca, Cambridge, UK. .,Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
| | - Peter B Vermeulen
- HistoGeneX, Antwerp, Belgium.,Translational Cancer Research Unit, GZA Hospitals St Augustinus, University of Antwerp, Wilrijk-Antwerp, Belgium.,Tumour Biology Team, Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Francesco Pezzella
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Robert S Kerbel
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Andrew R Reynolds
- Tumour Biology Team, Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK. .,Oncology Translational Medicine Unit, IMED Biotech Unit, AstraZeneca, Cambridge, UK.
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11
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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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12
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McDonald GB, Freston JW, Boyer JL, DeLeve LD. Liver Complications Following Treatment of Hematologic Malignancy With Anti-CD22-Calicheamicin (Inotuzumab Ozogamicin). Hepatology 2019; 69:831-844. [PMID: 30120894 PMCID: PMC6351187 DOI: 10.1002/hep.30222] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023]
Abstract
Treatment of hematological malignancy with antibody-drug conjugates (ADCs) may cause liver injury. ADCs deliver a toxic moiety into antigen-expressing tumor cells, but may also injure hepatic sinusoids (sinusoidal obstruction syndrome; SOS). We studied patients who received an anti-CD22/calicheamicin conjugate (inotuzumab ozogamicin; InO) to gain insight into mechanisms of sinusoidal injury, given that there are no CD22+ cells in the normal liver, but nonspecific uptake of ADCs by liver sinusoidal endothelial cells (LSECs). Six hundred thirty-eight patients (307 with acute lymphocytic leukemia [ALL], 311 with non-Hodgkin's lymphoma [NHL]) were randomized to either InO or standard chemotherapy (controls). While blinded to treatment assignment, we reviewed all cases with hepatobiliary complications to adjudicate the causes. Frequency of SOS among patients who received InO was 5 of 328 (1.5%), compared to no cases among 310 control patients. Drug-induced liver injury (DILI) developed in 26 (7.9%) InO recipients and 3 (1%) controls. Intrahepatic cholestasis (IHC) was observed in 4.9% of InO recipients and in 5.5% of controls. Subsequent to the randomization study, 113 patients with ALL underwent allogeneic hematopoietic cell transplantation (HCT); frequency of SOS in those previously exposed to InO was 21 of 79 (27%) versus 3 of 34 (9%) in controls. An exploratory multivariate model identified a past history of liver disease and thrombocytopenia before conditioning therapy as dominant risk factors for SOS after transplant. Conclusion: Frequencies of SOS and DILI after inotuzumab ozogamicin treatment were 1.5% and 7.9%, respectively, compared to none and 1% among controls who received standard chemotherapy. These data suggest that ADCs that do not target antigens present in the normal liver have a relatively low frequency of SOS, but a relatively high frequency of DILI.
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13
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Haefliger S, Milowich D, Sciarra A, Trimeche M, Bouilly J, Kaiser J, Volpi S, Brouland JP, Sempoux C, de Leval L. Primary hepatic marginal B cell lymphoma of mucosa-associated lymphoid tissue (MALT) and non-alcoholic steatohepatitis (NASH): more than a coincidence? Ann Hematol 2018; 98:1513-1516. [PMID: 30488325 DOI: 10.1007/s00277-018-3565-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Simon Haefliger
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland.
| | - Dina Milowich
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Amedeo Sciarra
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Mounir Trimeche
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Bouilly
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Julie Kaiser
- Department of Hematology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephanie Volpi
- Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Christine Sempoux
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurence de Leval
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
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14
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Hampel PJ, Chaffee KG, King RL, Simonetto D, Larson MC, Achenbach S, Call TG, Ding W, Kenderian SS, Leis JF, Chanan-Khan AA, Bowen DA, Conte MJ, Schwager SM, Hanson CA, Slager SL, Kay NE, Shanafelt TD, Parikh SA. Liver dysfunction in chronic lymphocytic leukemia: Prevalence, outcomes, and pathological findings. Am J Hematol 2017; 92:1362-1369. [PMID: 28940587 PMCID: PMC7219181 DOI: 10.1002/ajh.24915] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 01/03/2023]
Abstract
The prevalence of liver dysfunction and its association with outcomes in patients with previously untreated chronic lymphocytic leukemia (CLL) is unknown. Newly diagnosed (<12 months) previously untreated CLL patients seen at Mayo Clinic, Rochester, MN between 9/1993 and 4/2016 who had baseline assessment of at least one liver function test (LFT) were included in this analysis. The prevalence of liver dysfunction at baseline, proportion of patients who acquired LFT abnormalities, time to first therapy (TTFT) and overall survival (OS) were assessed. An abnormal LFT was present in 82/2336 (3.5%) patients at diagnosis and was associated with advanced Rai stage (Rai III-IV) (21% vs. 6%; P < .001), lower hemoglobin (13.1 g/dL vs. 13.9 g/dL; P < .001), and lower platelet count (187 × 109/L vs. 200 × 109/L; P = .03). Additionally, 236 patients with normal LFTs at diagnosis developed acquired liver dysfunction during follow-up. Patients with abnormal LFTs at diagnosis had a shorter OS compared to those with normal LFTs (HR 1.80 95% CI 1.13-2.87; P = .014, adjusted for age, sex, Rai stage, and treatment), although TTFT was not different. Of 52 patients who underwent a liver biopsy, CLL was present in liver tissue in 39/52 (73%) patients, with the portal tracts the most common region involved. Histopathology findings of liver involvement by CLL had limited correlation with choice of CLL therapy. In conclusion, approximately 1 of 25 newly diagnosed CLL patients has abnormal LFTs at diagnosis. Although the TTFT was not different among patients with abnormal LFTs, these patients have a shorter OS compared to those with normal LFTs.
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Affiliation(s)
- Paul J. Hampel
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kari G. Chaffee
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Rebecca L. King
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Douglas Simonetto
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Melissa C. Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Sara Achenbach
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Timothy G. Call
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Wei Ding
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Saad S. Kenderian
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jose F. Leis
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | | | - Deborah A. Bowen
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J. Conte
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Susan M. Schwager
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Curtis A. Hanson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Susan L. Slager
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Neil E. Kay
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tait D. Shanafelt
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sameer A. Parikh
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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15
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The Clinical Spectrum of Hepatic Manifestations in Chronic Lymphocytic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:863-869. [DOI: 10.1016/j.clml.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022]
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16
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Idelalisib given front-line for treatment of chronic lymphocytic leukemia causes frequent immune-mediated hepatotoxicity. Blood 2016; 128:195-203. [PMID: 27247136 DOI: 10.1182/blood-2016-03-707133] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/11/2016] [Indexed: 11/20/2022] Open
Abstract
Idelalisib is a small-molecule inhibitor of PI3Kδ with demonstrated efficacy for the treatment of relapsed/refractory chronic lymphocytic leukemia (CLL). To evaluate idelalisib as front-line therapy, we enrolled 24 subjects in a phase 2 study consisting of 2 months of idelalisib monotherapy followed by 6 months of combination therapy with idelalisib and the anti-CD20 antibody ofatumumab. After a median follow-up period of 14.7 months, hepatotoxicity was found to be a frequent and often severe adverse event. A total of 19 subjects (79%) experienced either grade ≥1 ALT or AST elevation during the study, and 13 subjects (54%) experienced grade ≥3 transaminitis. The median time to development of transaminitis was 28 days, occurring before ofatumumab introduction. Younger age and mutated immunoglobulin heavy chain status were significant risk factors for the development of hepatotoxicity. Multiple lines of evidence suggest that this hepatotoxicity was immune mediated. A lymphocytic infiltrate was seen on liver biopsy specimens taken from 2 subjects with transaminitis, and levels of the proinflammatory cytokines CCL-3 and CCL-4 were higher in subjects experiencing hepatotoxicity. All cases of transaminitis resolved either by holding the drug, initiating immunosuppressants, or both, and rates of recurrent toxicity were lower in patients taking steroids when idelalisib was reinitiated. A decrease in peripheral blood regulatory T cells was seen in patients experiencing toxicity on therapy, which is consistent with an immune-mediated mechanism. These results suggest that caution should be taken as drugs within this class are developed for CLL, particularly in younger patients who have not received prior disease-specific therapy. This study was registered at www.clinicaltrials.gov as #NCT02135133.
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17
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Herman SEM, Niemann CU, Farooqui M, Jones J, Mustafa RZ, Lipsky A, Saba N, Martyr S, Soto S, Valdez J, Gyamfi JA, Maric I, Calvo KR, Pedersen LB, Geisler CH, Liu D, Marti GE, Aue G, Wiestner A. Ibrutinib-induced lymphocytosis in patients with chronic lymphocytic leukemia: correlative analyses from a phase II study. Leukemia 2014; 28:2188-96. [PMID: 24699307 PMCID: PMC4185271 DOI: 10.1038/leu.2014.122] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/21/2014] [Accepted: 03/21/2014] [Indexed: 02/06/2023]
Abstract
Ibrutinib and other targeted inhibitors of B-cell receptor signaling achieve impressive clinical results for patients with chronic lymphocytic leukemia (CLL). A treatment-induced rise in absolute lymphocyte count (ALC) has emerged as a class effect of kinase inhibitors in CLL and warrants further investigation. We here report correlative studies in 64 patients with CLL treated with ibrutinib. We quantified tumor burden in blood, lymph nodes, spleen, and bone marrow, assessed phenotypic changes of circulating cells, and measured whole blood viscosity. With just one dose of ibrutinib the average increase in ALC was 66%, and in over 40% of patients the ALC peaked within 24 hours of initiating treatment. Circulating CLL cells on day 2 showed increased Ki67 and CD38 expression, indicating an efflux of tumor cells from the tissue compartments into the blood. The kinetics and degree of the treatment-induced lymphocytosis was highly variable; interestingly in patients with a high baseline ALC the relative increase was mild and resolution rapid. After two cycles of treatment the disease burden in lymph node, bone marrow, and spleen decreased irrespective of the relative change in ALC. Whole blood viscosity was dependent on both ALC and hemoglobin. No adverse events were attributed to the lymphocytosis.
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Affiliation(s)
- S E M Herman
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - C U Niemann
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - M Farooqui
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Jones
- 1] Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA [2] Medical Research Scholars Program, National Institutes of Health, Bethesda, MD, USA
| | - R Z Mustafa
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Lipsky
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - N Saba
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Martyr
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - S Soto
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Valdez
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J A Gyamfi
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - I Maric
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - K R Calvo
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - L B Pedersen
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C H Geisler
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - D Liu
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - G E Marti
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - G Aue
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - A Wiestner
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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18
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Brunt EM, Gouw ASH, Hubscher SG, Tiniakos DG, Bedossa P, Burt AD, Callea F, Clouston AD, Dienes HP, Goodman ZD, Roberts EA, Roskams T, Terracciano L, Torbenson MS, Wanless IR. Pathology of the liver sinusoids. Histopathology 2014; 64:907-20. [PMID: 24393125 DOI: 10.1111/his.12364] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The hepatic sinusoids comprise a complex of vascular conduits to transport blood from the porta hepatis to the inferior vena cava through the liver. Under normal conditions, portal venous and hepatic artery pressures are equalized within the sinusoids, oxygen and nutrients from the systemic circulation are delivered to the parenchymal cells and differentially distributed throughout the liver acini, and proteins of liver derivation are carried into the cardiac/systemic circulation. Liver sinusoid structures are lined by endothelial cells unique to their location, and Kupffer cells. Multifunctional hepatic stellate cells and various immune active cells are localized within the space of Disse between the sinusoid and the adjacent hepatocytes. Flow within the sinusoids can be compromised by physical or pressure blockage in their lumina as well as obstructive processes within the space of Disse. The intimate relationship of the liver sinusoids to neighbouring hepatocytes is a significant factor affecting the health of hepatocytes, or transmission of the effects of injury within the sinusoidal space. Pathologists should recognize several patterns of injury involving the sinusoids and surrounding hepatocytes. In this review, injury, alterations and accumulations within the liver sinusoids are illustrated and discussed.
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Affiliation(s)
- Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University, School of Medicine, St Louis, MO, USA
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Murakami J, Shimizu Y. Hepatic manifestations in hematological disorders. Int J Hepatol 2013; 2013:484903. [PMID: 23606974 PMCID: PMC3626309 DOI: 10.1155/2013/484903] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 12/17/2022] Open
Abstract
Liver involvement is often observed in several hematological disorders, resulting in abnormal liver function tests, abnormalities in liver imaging studies, or clinical symptoms presenting with hepatic manifestations. In hemolytic anemia, jaundice and hepatosplenomegaly are often seen mimicking liver diseases. In hematologic malignancies, malignant cells often infiltrate the liver and may demonstrate abnormal liver function test results accompanied by hepatosplenomegaly or formation of multiple nodules in the liver and/or spleen. These cases may further evolve into fulminant hepatic failure.
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Affiliation(s)
- Jun Murakami
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yukihiro Shimizu
- Gastroenterology Unit, Takaoka City Hospital, Toyama 933-8550, Japan
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20
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Shetty S, Bruns T, Weston CJ, Stamataki Z, Oo YH, Long HM, Reynolds GM, Pratt G, Moss P, Jalkanen S, Hubscher SG, Lalor PF, Adams DH. Recruitment mechanisms of primary and malignant B cells to the human liver. Hepatology 2012; 56:1521-31. [PMID: 22508288 DOI: 10.1002/hep.25790] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
UNLABELLED B cells are present within chronically inflamed liver tissue and recent evidence implicates them in the progression of liver disease. In addition, a large proportion of hepatic lymphomas are of B-cell origin. The molecular signals that regulate normal and malignant B-cell recruitment into peripheral tissue from blood are poorly understood, leading us to study human B-cell migration through hepatic sinusoidal endothelial cells in flow-based adhesion assays. In such assays, human blood-derived B cells were captured from shear flow without a previous rolling phase and underwent firm adhesion mediated by vascular cell adhesion molecule-1 (VCAM-1). Unlike T cells, which displayed vigorous crawling behavior on the endothelium, B cells remained static before a proportion underwent transendothelial migration mediated by a combination of intercellular adhesion molecule-1 (ICAM-1), vascular adhesion protein-1, common lymphatic endothelial and vascular endothelial receptor-1/stabilin-1, and the chemokine receptors, CXCR3 and CXCR4. B-cell lymphoma cell lines and primary malignant B cells from patients with chronic lymphocytic leukemia and marginal zone B cell lymphoma also underwent integrin-mediated firm adhesion involving ICAM-1 and/or VCAM-1 and demonstrated ICAM-1-dependent shape-change and crawling behavior. Unlike primary lymphocytes, the malignant cells did not undergo transendothelial migration, which could explain why lymphomas are frequently characterized by the intravascular accumulation of malignant cells in the hepatic sinusoids. CONCLUSION Our findings demonstrate that distinct combinations of signals promote B-cell recruitment to the liver, suggesting the possibility of novel targets to modulate liver inflammation in disease. Certain features of lymphocyte homing are maintained in lymphoma recruitment to the liver, suggesting that therapeutic targets for lymphocyte recruitment may also prevent hepatic lymphoma dissemination.
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Affiliation(s)
- Shishir Shetty
- Center for Liver Research, School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom.
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21
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Chronic lymphocytic leukemia-associated cholangiopathy. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2011; 25:356-7. [PMID: 21876854 DOI: 10.1155/2011/176836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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22
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Multinodular pseudolymphoma of the liver: computed tomography and magnetic resonance imaging findings. Jpn J Radiol 2011; 29:524-7. [PMID: 21882097 DOI: 10.1007/s11604-011-0581-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/23/2011] [Indexed: 02/07/2023]
Abstract
A 60-year-old woman who had had a history of renal cell carcinoma with intraperitoneal recurrence presented with multiple liver masses. Computed tomography demonstrated multiple enhancing lesions in the both lobes of the liver, and there was an apparent small vessel coursing within one of the lesions. On magnetic resonance imaging, masses showed slight T1 and T2 prolongation, and restricted diffusion: On the hepatobiliary phase of liver-specific contrast agent enhancement, lesions were shown as low signal intensity of varying degree. Liver metastases from renal cell carcinoma were suspected, and partial hepatectomy was performed for the superficially located nodules to make a definitive diagnosis. The final pathological diagnosis was reactive lymphoid hyperplasia or pseudolymphoma of the liver.
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Abstract
Malignant and nonmalignant disorders may affect the liver, causing signs and symptoms ranging from mild increases of liver tests to fulminant hepatic failure. This article discusses the most common hematologic and oncologic disorders and their effect on the liver. The section on nonmalignant hematologic disorders includes the anemias, paroxysmal nocturnal hemoglobinuria, disseminated intravascular coagulation, malaria, Banti syndrome, the porphyrias, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome. Malignant hematologic conditions include leukemias, lymphomas, and myeloproliferative disorders. Other conditions causing portal hypertension and hepatic metastases are also discussed. The most commonly encountered hepatic manifestations of hematologic and oncologic disorders are reviewed.
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Affiliation(s)
- Marvin M Singh
- Division of Gastroenterology and Hepatology, Scripps Clinic Torrey Pines, and The Scripps Research Institute, 10666 North Torrey Pines Road, N 203 La Jolla, CA 92037, USA
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24
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Silvestris N, Zito FA, Fiore MG, Simone G, Tommasi S, Izzi G, Guarini A, Colucci G. Synchronous presentation of B-cell chronic lymphocytic leukemia/small-cell lymphoma and colon adenocarcinoma within the same mesenteric lymph nodes and a single liver metastasis. J Clin Oncol 2010; 29:e11-3. [PMID: 20940198 DOI: 10.1200/jco.2010.31.1001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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25
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Zen Y, Fujii T, Nakanuma Y. Hepatic pseudolymphoma: a clinicopathological study of five cases and review of the literature. Mod Pathol 2010; 23:244-50. [PMID: 19915525 DOI: 10.1038/modpathol.2009.165] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hepatic pseudolymphoma is a rare and controversial condition, the clinicopathological characteristics of which have not been well documented. In this study, we retrospectively examined clinical and pathological features of five patients (two males and three females, 40-81 years old) with hepatic pseudolymphoma. Two patients had multiple lesions (two lesions each). Three patients had histories of chronic liver disorders, including primary biliary cirrhosis, nonalcoholic steatohepatitis, and chronic viral hepatitis B. Tumor sizes ranged from 0.5 to 5.5 cm in diameter (average, 2.1 cm). Histologically, hepatic pseudolymphoma consisted of tumorous infiltrates of mature lymphocytes with multiple lymph follicles or clusters of epithelioid histiocytes. Lymphocytes characteristically extended into nearby portal tracts. Ductal structures positive for cytokeratin 7 were entrapped in the peripheral parts of nodules. In situ hybridization of immunoglobulin light chains revealed B lymphocytes and plasma cells to be polyclonal. In addition, clonal rearrangements of immunoglobulin heavy chains could not be shown in any cases using PCR. Two patients were diagnosed by needle biopsy. Interestingly, their nodules spontaneously diminished in size without any treatment. Malignant transformation was not observed in any cases during the follow-up periods. In conclusion, this study revealed that hepatic pseudolymphoma had benign behavior. The diagnosis of hepatic pseudolymphoma can be challenging especially with biopsied specimens, but could be aided by a characteristic growth pattern, in situ hybridization, analyses of gene rearrangements, or a follow-up based on images.
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Affiliation(s)
- Yoh Zen
- Institute of Liver Studies, King's College Hospital, London SE5 9RS, UK.
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26
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F-18 FDG PET/CT Findings in A Case of T-Cell Lymphoma-Associated Hemophagocytic Syndrome With Liver Involvement. Clin Nucl Med 2010; 35:116-20. [DOI: 10.1097/rlu.0b013e3181c7bf20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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27
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Kwee TC, Takahara T, Vermoolen MA, Bierings MB, Mali WP, Nievelstein RAJ. Whole-body diffusion-weighted imaging for staging malignant lymphoma in children. Pediatr Radiol 2010; 40:1592-602; quiz 1720-1. [PMID: 20676622 PMCID: PMC2940028 DOI: 10.1007/s00247-010-1775-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Revised: 11/25/2009] [Accepted: 12/20/2009] [Indexed: 11/04/2022]
Abstract
CT is currently the mainstay in staging malignant lymphoma in children, but the risk of second neoplasms due to ionizing radiation associated with CT is not negligible. Whole-body MRI techniques and whole-body diffusion-weighted imaging (DWI) in particular, may be a good radiation-free alternative to CT. DWI is characterized by high sensitivity for the detection of lesions and allows quantitative assessment of diffusion that may aid in the evaluation of malignant lymphomas. This article will review whole-body MRI techniques for staging malignant lymphoma with emphasis on whole-body DWI. Furthermore, future considerations and challenges in whole-body DWI will be discussed.
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Affiliation(s)
- Thomas C. Kwee
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Taro Takahara
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Malou A. Vermoolen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marc B. Bierings
- Department of Pediatric Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem P. Mali
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Rutger A. J. Nievelstein
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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