Association of idiopathic hepatic sinusoidal dilatation with the immunological features of the antiphospholipid syndrome.
BACKGROUND
Isolated sinusoidal dilatation is an uncommon hepatic lesion and the cause is largely unknown.


OBJECTIVE
To investigate whether prothrombotic disorders or perisinusoidal cell changes could be involved in pure idiopathic hepatic sinusoidal dilatation (HSD).


METHODS
Evaluation for associated conditions, prothrombotic disorders, and studies of hepatic perisinusoidal cell activation in consecutive patients, seen between 1993 and 2002, with isolated sinusoidal dilatation unrelated to outflow block, sinusoidal infiltration, or hepatic granulomas.


RESULTS
Among 11 patients, associated conditions were prothrombotic disorders (n = 5) and oral contraceptive use (n = 3). Prothrombotic disorders were polycythemia vera (n = 1) and anticardiolipin antibodies combined with lupus anticoagulant (n = 4). No genetic thrombophilia factor was found. Of four patients with lupus anticoagulant, three had antinuclear factors and high serum levels of anticardiolipin antibodies at repeated testing. There was no evidence of intrahepatic or extrahepatic thrombosis in any of the patients. Sinusoidal dilatation was marked in six of 11 patients (54%), including two patients with antiphospholipid antibodies. Activated perisinusoidal cells were only found around markedly dilated sinusoids.


CONCLUSIONS
Idiopathic pure HSD is frequently associated with the immunological features of the antiphospholipid syndrome. Therefore, finding pure HSD in a liver biopsy specimen should prompt the search for antiphospholipid antibodies.
Saadoun
D
D
Service d'Hépatologie, Hôpital Beaujon, 92118 Clichy, France.
Cazals-Hatem
D
D
Denninger
M-H
MH
Boudaoud
L
L
Pham
B-N
BN
Mallet
V
V
Condat
B
B
Brière
J
J
Valla
D
D
D000328:Adult; D017153:Antibodies, Anticardiolipin / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D016736:Antiphospholipid Syndrome / Q000175:diagnosis*; D001706:Biopsy; D004108:Dilatation, Pathologic / Q000276:immunology / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000473:pathology; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D008875:Middle Aged
D017153:Antibodies, Anticardiolipin; D000974:Antibodies, Antinuclear; D016682:Lupus Coagulation Inhibitor