Hepatic Sinusoidal Obstruction Syndrome Induced by Non-transplant Chemotherapy for Non-Hodgkin Lymphoma

Abstract

Hepatic sinusoidal obstruction syndrome (SOS), a serious complication that mainly occurs after hematopoietic-stem cell transplantation (HSCT), is caused by damage to the sinusoidal endothelial cells after the obstruction of the sinusoid. Recently, hepatic SOS was reported to occur after non-HSCT chemotherapies. This report describes a patient who experienced hepatic SOS after non-HSCT chemotherapy for non-Hodgkin lymphoma. A liver biopsy showed the slight dilatation of the hepatic sinusoid, which may be indicative of hepatic SOS. Hepatic SOS should be included in the differential diagnosis of patients with severe liver injury following the administration of chemotherapy regimens that are toxic to the vascular endothelial cells.

Figure 1.

A)-B) The esophagogastroduodenoscopy findings. A) The stomach. The red arrowheads indicate irregular ulcer lesions in the body of the stomach. B) The duodenum. The red arrowheads indicate multiple flat elevations in the second portion of the duodenum. Biopsies were performed from <1-<2 and <4-<6, and all of the samples revealed diffuse large B-cell lymphoma. C)-E) The contrast-enhanced computed tomography findings. C) A CT image showing the enlargement of multiple lymph nodes from the neck. D) A CT image showing a thickened gastric wall caused by lymphomatous lesion. E) A CT image showing the ascites on the surface of the liver. A cytological analysis of the ascites revealed class V.

Figure 2.

A) The clinical course of the present patient, including the timing of CT (as shown as B-E). NM: nafamostat mesilate, G: glycyrrhizic acid, UDCA: ursodeoxycholic acid. B) A contrast-enhanced CT image shows hepatomegaly and geographic low density area at the posterior segment of the liver. C)-E) CT images showing the increase of ascites and the progression of liver atrophy.

Figure 3.

The liver biopsy results. A) Hematoxylin and Eosin (H&E) staining (×20). Hepatocellular necrosis was not observed in the lobular and periportal area. B) H&E staining (×400). The arrow represents a bile plug. C) H&E staining (×100). The arrow represents a preserved bile duct. Mild inflammation was observed in the portal area. D) H&E staining (×20) showing congestion in the parenchymal area. E) H&E staining (×200) the arrowhead shows dilatation of the sinusoid and congestion caused by erythrocytes. F) Azan-Mallory staining (×400). The arrow represents the central vein which shows no venular occlusion.

Figure 4.

The pathological findings of the liver at autopsy. A) The macroscopic findings of the liver. Congestion and cholestasis are found. B) H&E staining (×400) showing the dilation of the sinusoid due to erythrocytes (arrowhead) and a bile plug (arrow). C) Azan staining (×400) showing the growth of connective tissue under the sinusoidal endothelial cells (arrowhead). D) H&E stainingg (×20) showing the congestion of the parenchyma. E) H&E staining (×400) showing stenosis of the central vein (arrowhead) and ischemic necrosis of the hepatocytes. F) Azan staining (×400) showing the deposition of connective tissue around the central vein, which caused stenosis of the central vein (arrowhead). CV: central vein