The clinical-biochemical and morphological peculiarities of liver injury in patients with hematologic malignancies

Abstract

Objective — to define frequency of liver infiltration by tumor cells against the background of hematologic malignancies and compare the character of pathomorphological and biochemical peculiarities of hepatotoxic reactions.Materials and methods. The investigation has been performed on autopsies samples of 31 deceased patients of 36 — 80 years old, from them 20 (64.5 %) were males and 11 (35.4 %) females. Frequency of liver tissue infiltration depending on the type of hemoblastosis was determined. The clinical data of a patient with multiple myeloma, who underwent four courses of chemotherapy in Сycle-Thal-Dex regimen, have been assessed.Results. Frequency of liver infiltration by tumor was reveled in 54.8 % of patients, deсeased against the background of hemoblastosis progression. In patients with acute leukemias and chronic myeloproliferative diseases at the phase of blast crisis, the liver infiltration occurred in 50 - 66 % of cases, and with chronic lymphoproliferative diseases in 33.3 % cases. Multiple myeloma was associated with higher risk of liver tumor infiltration compared to acute leukemias (RR = 1.87; 95 % СІ = 1.16 — 3.01; р < 0.05).Data of clinical case investigation showed that before cytostatical therapy, the readings of functional liver state were within normal limits. The blood biochemistry results showed up to two-fold elevation of the upper normal level in the activity of alanine aminotransferase, gamma-glutamyl transpeptidase and alkaline phosphatase in the course of specific therapy that disappeared without any additional therapy. Liver injury, revealed during pathohistological investigation, was characterized by macrovesicular liver steatosis, intrahepatic cholestasis, massive plasma cells infiltrates formation, and small plasma cells infiltrates with damage of pericentral zones of acinus.Conclusions. Multiple myeloma and its specific chemotherapy results in the formation of a wide range of morphological liver disorders which may not manifest in the changes of blood biochemical parameters.