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Okano H, Tanaka H, Matsusaki S, Mukai K, Nishimura A, Asakawa K, Baba Y, Murata T. Detection of Lymphadenopathy as a Precursor to Autoimmune Liver Diseases Before Clinical Hepatitis Became Apparent: A Report of Two Cases. Cureus 2023; 15:e47595. [PMID: 38022336 PMCID: PMC10665763 DOI: 10.7759/cureus.47595] [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] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Two patients were incidentally diagnosed with intra-abdominal lymphadenopathy on imaging examinations. Although endoscopic ultrasound-guided fine needle aspiration of these areas of lymphadenopathy was performed, their causes remained undetermined. Neither patients had abnormal hepatic enzyme levels at the time lymphadenopathy was detected, but they developed hepatitis 20 months and five months later, respectively. The laboratory data and/or histopathological findings suggested primary biliary cholangitis/cirrhosis (PBC) and autoimmune hepatitis (AIH), respectively. These two patients were each started on appropriate treatment (ursodeoxycholic acid or prednisolone, respectively), their hepatitis ameliorated, and the hepatic enzyme levels recovered to within the normal ranges. These patients' clinical courses suggest that their lymphadenopathy was associated with PBC or AIH and appeared before the causative hepatitis became clinically apparent. We should consider the possibility of latent autoimmune hepatic diseases in cases with cryptogenic intra-abdominal lymphadenopathy even if there is no clinically apparent hepatitis.
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Affiliation(s)
- Hiroshi Okano
- Gastroenterology, Suzuka General Hospital, Suzuka, JPN
| | - Hiroki Tanaka
- Gastroenterology, Suzuka General Hospital, Suzuka, JPN
| | | | - Katsumi Mukai
- Gastroenterology, Suzuka General Hospital, Suzuka, JPN
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The Enlargement of Abdominal Lymph Nodes Is a Characteristic of Autoimmune Liver Disease. Mediators Inflamm 2020; 2020:3631625. [PMID: 32273828 PMCID: PMC7115048 DOI: 10.1155/2020/3631625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background The enlargement of lymph nodes is a common clinical sign in connective tissue disease (CTD) and viral hepatitis. In this research, we evaluated the incidence of enlarged lymph nodes in autoimmune liver diseases (AILD). Moreover, we identified the clinical significance of abdominal lymph node enlargement in AILD. Methods The characteristics of abdominal lymph nodes, including their morphology and distribution, were assessed by ultrasonography and computed tomography in 125 patients with AILD, 54 with viral hepatitis, 135 with CTD, and 80 healthy controls. The pathological and laboratory results of 106 AILD patients were collected to analyze the association between lymphadenectasis and disease activity. Results Enlargement of abdominal lymph nodes was found in 69.6% of patients with AILD, 63% of patients with viral hepatitis, 29.6% of patients with CTD, and 2% of healthy controls. Alkaline phosphatase (ALP), glutamate transpeptidase (GGT), and immunoglobulin M (IgM) levels were significantly increased in AILD patients with lymphadenectasis (LA) in contrast to patients without lymphadenectasis (NLA) (P < 0.05). The pathological characteristics of inflammation, cholestasis, and focal necrosis were more common in the LA group than in the NLA group (P < 0.05). As shown by multivariate logistic regression analysis, interface hepatitis (OR = 3.651, P < 0.05), cholestasis (OR = 8.137, P < 0.05), and focal necrosis (OR = 5.212, P < 0.05) were related to LA. Conclusions The percentage of abdominal lymph node enlargement in AILD subjects was significantly higher than that in CTD subjects. Therefore, the enlargement of lymph nodes can represent a noninvasive indicator of histological and biochemical inflammation activity in AILD.
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Yu J, Chen Y, Wu Y, Ye L, Lian Z, Wei H, Sun R, Tian Z. The differential organogenesis and functionality of two liver-draining lymph nodes in mice. J Autoimmun 2017; 84:109-121. [PMID: 28886898 DOI: 10.1016/j.jaut.2017.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/13/2022]
Abstract
The liver is an immunological organ. However, fundamental knowledge concerning liver-draining lymph nodes (LNs), which have been newly identified in mice as the portal and celiac LNs, is still lacking. Here, we revealed that the portal LN and celiac LN drain liver lymph through different lymphatic vessels. Although both the portal LN and celiac LN possess typical structures, they have different cell compositions. Interestingly, these two LNs form at different times during fetal development. Moreover, the organogenesis of the celiac LN, but not the portal LN, is controlled by the transcription factor NFIL3. Furthermore, the portal LN and celiac LN also perform different functions. The celiac LN is the predominant site of liver antiviral immune responses, whereas the portal LN functions in the in situ induction of dietary antigen-specific regulatory T cells. In conclusion, the portal LN and celiac LN are two independent liver-draining LNs with different organogenesis histories and separate functions in maintaining immune homeostasis in the liver.
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Affiliation(s)
- Jiali Yu
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Yongyan Chen
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Yuzhang Wu
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China.
| | - Lilin Ye
- Institute of Immunology, Third Military Medical University, Chongqing, 400038, China
| | - Zhexiong Lian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Haiming Wei
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Rui Sun
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Zhigang Tian
- Hefei National Laboratory for Physical Sciences at Microscale, The Key Laboratory of Innate Immunity and Chronic Disease (Chinese Academy of Science), Institute of Immunology, School of Life Sciences and Medical Center, University of Science and Technology of China, Hefei, Anhui 230027, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
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Merkow J, Paniccia A, Jones E, Jones T, Hodges M, Stovall R, Kounalakis N, Gajdos C, Lewis K, Robinson W, Gonzalez R, Pearlman N, McCarter M. Association of sentinel lymph node diameter with melanoma metastasis. Am J Surg 2016; 212:315-20. [PMID: 26827186 DOI: 10.1016/j.amjsurg.2015.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/06/2015] [Accepted: 09/22/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lymph nodes are an important part of the immune system and the size of the lymph node reflects local immunologic activity. The purpose of this study was to examine the association between sentinel lymph node (SLN) size and the presence of nodal metastasis in patients with melanoma. METHODS Retrospective review of a prospectively maintained database of patients undergoing SLN biopsy for cutaneous melanoma between February 1995 and January 2013. The maximum pathologic diameter and the volume of the largest node was used. A nodal diameter of 1.5 cm, included in 2 interquartile ranges of both positive and negative SLNs, was used as the cutoff for multivariate regression. RESULTS Of 1,017 SLN biopsies, 826 (81%) had complete size measurements and were included in the analysis. Patients with a positive SLN were younger (median 50 vs 53 years, P = .032), had deeper primary lesions (2 vs 1.4 mm, P < .001), and had larger SLN volume (.8 vs .6 cc, P = .009) or maximum diameter (1.9 vs. 1.6 cm, P = .03). Sex, pathologic ulceration, mitosis, and the type or location of the primary was not statistically different. On multivariate analysis; age, depth of primary, and both SLN volume and maximum diameter remained significant. An SLN greater than 1.5 cm in maximum diameter has a 60% increased odds ratio of being positive after adjusting for age, sex, and depth of primary lesion (P = .046). CONCLUSIONS Larger SLN maximum diameter is associated with nodal positivity independent of age, sex, depth of primary lesion, and location of SLN biopsy. The etiology and significance of larger SLNs warrant further analysis.
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Affiliation(s)
- Justin Merkow
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Alessandro Paniccia
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Edward Jones
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Teresa Jones
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Maggie Hodges
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Robert Stovall
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Nicole Kounalakis
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Csaba Gajdos
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Karl Lewis
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - William Robinson
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Rene Gonzalez
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Nathan Pearlman
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA
| | - Martin McCarter
- Department of Surgery, School of Medicine, University of Colorado, Anschutz Medical Campus, Room 5401, 12631 E. 17th Ave., C302, Aurora, CO 80045, USA.
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Zhou C, Jia HM, Liu YT, Yu M, Chang X, Ba YM, Zou ZM. Metabolism of glycerophospholipid, bile acid and retinol is correlated with the early outcomes of autoimmune hepatitis. MOLECULAR BIOSYSTEMS 2016; 12:1574-85. [DOI: 10.1039/c6mb00092d] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study first reports the metabolic variations at the early stage of the liver injury related to autoimmune hepatitis.
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Affiliation(s)
- Chao Zhou
- Institute of Medicinal Plant Development
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing 100193
- P. R. China
| | - Hong-mei Jia
- Institute of Medicinal Plant Development
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing 100193
- P. R. China
| | - Yue-tao Liu
- Institute of Medicinal Plant Development
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing 100193
- P. R. China
| | - Meng Yu
- Institute of Medicinal Plant Development
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing 100193
- P. R. China
| | - Xing Chang
- Institute of Medicinal Plant Development
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing 100193
- P. R. China
| | - Yuan-ming Ba
- Hubei Provincial Hospital of TCM
- Wuhan
- P. R. China
| | - Zhong-mei Zou
- Institute of Medicinal Plant Development
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing 100193
- P. R. China
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Naito A, Terada J, Tanabe N, Sugiura T, Sakao S, Kanda T, Yokosuka O, Tatsumi K. Autoimmune hepatitis in a patient with pulmonary arterial hypertension treated with endothelin receptor antagonists. Intern Med 2014; 53:771-5. [PMID: 24694495 DOI: 10.2169/internalmedicine.53.1362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 48-year-old woman was diagnosed with idiopathic pulmonary arterial hypertension (PAH) and administered PAH-specific therapies, including bosentan. Four years after the initiation of treatment with bosentan, liver dysfunction appeared, and ambrisentan was substituted for bosentan. One-and-a half years later, a second episode of liver dysfunction occurred. The pathological findings of a liver biopsy specimen were not definitive, although drug-induced hepatotoxicity caused by ambrisentan was considered. However, the patient's liver dysfunction did not improve even after the discontinuation of ambrisentan. Finally, we diagnosed her with autoimmune hepatitis (AIH). Providing careful observation with a suspicion of AIH is important when treating PAH patients with autoantibodies.
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Affiliation(s)
- Akira Naito
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
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