Patterns Of Liver Involvement Research Articles

Pattern and Prevalence of Liver Involvement in Pediatric Acute Lymphoblastic and Myeloid Leukemia at Diagnosis.

The prevalence and significance of liver involvement at diagnosis was studied in pediatric acute lymphoblastic (ALL) and myeloid leukemia (AML). A population based cohort of 122 pre B-ALL, 22 T-ALL and 45 AML patients was formed from the Nordic Society of Pediatric Hematology and Oncology leukemia registries (years 2005-2017). Hepatomegaly, elevated alanine aminotransferase, high INR, hypoalbuminemia and conjugated hyperbilirubinemia at diagnosis were used as markers for liver involvement. Minimal residual disease (MRD), time to relapse and overall survival (OS) were correlated with liver involvements. The pattern of liver involvement was significantly different between leukemia subtypes (P = 0.025). The proportion of patients without liver abnormalities was 50.0% in AML and 44.8% in pre B-ALL and 23.5% in T-ALL patients. Hepatomegaly characterized lymphatic leukemia being present in 41.8% and 58.8% of pre B- and T-ALL patients. Liver dysfunction was most common in AML (29.5%) and least frequent in pre B-ALL (7.4%,) (P = 0.001). Conjugated hyperbilirubinemia was present in less than 5% of patients. Hepatomegaly correlated positively with age in pre B-ALL (P = 0.036) and white blood cell count (WBC) in AML (P = 0.010). Hepatic dysfunction was related with high WBC in pre B-ALL (P = 0.037) and AML (P = 0.001). Liver involvement in patients with ALL was not associated with toxicity or outcome. Patients with AML without liver involvement demonstrated superior OS. Liver involvement is frequent at diagnosis in pediatric leukemia and its prevalence is related with leukemia subtype, age and WBC. In AML, but not in ALL, it associates with suboptimal prognosis.

A Study on Spectrum of Hepatobiliary Dysfunctions and Pattern of Liver Involvement in Dengue Infection.

The most common arthropod-borne viral (arboviral) disease in humans is dengue. It is transmitted by female Aedes mosquitoes. These mosquitoes are widely distributed in subtropical and tropical areas of the world. Study of dengue infection and its complications are rare from countries like India. In this prospective observational cross-sectional study, we intended to assess the frequency and degree of hepatobiliary dysfunction in adult patients with dengue infection presenting to a tertiary-care medical facility. The details of all patients with serologically proved dengue fever admitted to a tertiary care hospital in eastern India from July 2014 to June 2015 were prospectively reviewed. We collected data including routine blood count, Liver Function Test (LFT), Prothrombin Time (PT), Activated Partial Prothrombin Time (APTT), abdominal ultrasonography from 110 patients. The maximum number of cases were seen in the age group between 46 years and 61 years and of all cases 55.5% were male and 44.5% were female. Pain abdomen and vomiting were the commonest presenting complaints next to fever which was present in all the cases. Elevated liver enzymes, abnormal values of PT and APTT, thrombocytopenia were observed more commonly in Dengue Shock Syndrome (DSS). Gall bladder wall thickening, thrombocytopenia were seen more commonly in both DSS and Dengue Haemorrhagic Fever (DHF). Plasma leakage such as ascites and pleural effusion on USG were seen more frequently in patients with DHF (76.9% and 73.1%) followed by DSS (72% and 68%) and DF (33.9% and 32.2%). Hepatobiliary derangement is seen more commonly in severe case of dengue infection. Early recognition of these parameters can also be used as a predictor for assessing the disease severity.

Incidence and Pattern of Liver Involvement in Haematological Malignancies

The incidence and pattern of liver involvement in 127 liver specimens (2 biopsy and 125 autopsy specimens) from cases of acute myelogenous leukaemia (25), chronic myelogenous leukaemia (7), acute lymphatic leukaemia (5), chronic lymphatic leukaemia (9), multiple myeloma (25), low-grade non-Hodgkin's lymphoma (25), high-grade non-Hodgkin's lymphoma (24) and myeloproliferative diseases (7) were investigated histologically and immunohistochemically. Liver infiltration was found frequently in chronic leukaemia and myeloproliferative diseases (80-100%), acute leukaemia (60-70%) and non-Hodgkin's lymphoma (50-60%), but was significantly less common in multiple myeloma (32%) than in any of the other diagnostic groups. Hepatomegaly was found in over 50% of cases in all the diagnostic groups, but was not always associated with infiltration. Diffuse, non-destructive infiltration was most common: in acute myelogenous leukaemia, both the portal triads and sinusoids were usually involved; in chronic myelogenous leukaemia, multiple myeloma and myeloproliferative diseases, infiltration was mainly sinusoidal; and in lymphatic leukaemia and non-Hodgkin's lymphoma the portal triads were mainly involved. Nodular infiltration was seen in multiple myeloma and non-Hodgkin's lymphoma. The primary tumours and liver infiltrates generally exhibited the same immunophenotype, although reactivity with the antibody L26 (CD20) was only found in the primary lesion in many high-grade B-cell lymphomas. Thus, liver involvement is common in haematological malignancies, but the incidence and pattern of infiltration vary amongst the different types.

The hepatic sinusoid in hairy cell leukemia: An ultrastructural study of 12 cases

Ultrastructural lesions of the liver were studied in 12 cases of hairy cell leukemia, with the alterations of the sinusoidal barrier receiving special emphasis. Portal and sinusoidal tumoral infiltration was observed in all cases. It was associated with angiomatous lesions of the sinusoids in eight cases; these lesions consisted of randomly distributed cavities lined by hairy cells and containing hairy cells and erythrocytes. In addition to the attachment of hairy cells to the sinusoidal wall, other striking electron microscopic abnormalities of the sinusoids included 1) wide areas of communication between the sinusoidal lumen and Disse's space, allowing extravasation of blood cells; 2) focal disruption of the sinusoidal wall; and 3) replacement of the sinusoidal cell lining by tumor cells in close contact with hepatocytes. Most of these changes closely resembled those observed in peliosis hepatis. As in peliosis, sinusoidal alterations in hairy cell leukemia might be due to the destruction of the sinusoidal wall, and tumor cells could play a role in the pathogenesis of the lesions. The pattern of liver involvement in hairy cell leukemia, which is peculiar among hepatic localizations of blood malignancies, might reflect the unique phenotype of the tumor cells.