Bridging necrosis and reticulin bridging fibrosis induced by intrahepatic involvement of acute biphenotypic leukemia.
A 47-year-old Japanese woman was diagnosed as having acute biphenotypic leukemia with association of t(9;22)(q34;q11). Cholestatic liver dysfunction arose, and she died of cachexia and intracranial hemorrhage. Autopsy showed unusual hepatic fibrosis. In the liver, bridging infiltration, bridging necrosis and bridging fibrosis by leukemic cells were seen. It seemed that the degree of fibrosis was associated with the number of aggregates of infiltrating leukemic cells. The fibrotic foci were predominantly composed of reticulin and collagen fibers, and distortion of the lobules was observed. Immunohistochemically, dense bundles of alpha-smooth muscle actin (ASMA)-positive stromal cells, namely activated hepatic stellate cells (HSCs), were observed in the immature fibrotic foci as well as along the sinusoids densely infiltrated by leukemic cells. No cells positive for TGF-beta1 or PDGF-BB were identified. In conclusion, extensive intrahepatic involvement by neoplastic cells in adult acute biphenotypic leukemia may cause the unusual "disorganized" hepatic fibrosis.
Kuroda
N
N
Department of Pathology and Laboratory Medicine, Kochi Red Cross Hospital, Kochi City, Kochi, Japan. nkurodakrch@yahoo.co.jp
Mizobuchi
M
M
Shimamura
Y
Y
Daibata
M
M
Miyoshi
I
I
Ohara
M
M
Hirouchi
T
T
Mizuno
K
K
Lee
G H
GH
D000077214:Becaplermin; D003094:Collagen / Q000378:metabolism; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015470:Leukemia, Myeloid, Acute / Q000378:metabolism / Q000473:pathology*; D008103:Liver Cirrhosis / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D009336:Necrosis; D010982:Platelet-Derived Growth Factor / Q000096:biosynthesis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000378:metabolism / Q000473:pathology*; D020574:Proto-Oncogene Proteins c-sis; D012155:Reticulin / Q000378:metabolism; D053773:Transforming Growth Factor beta1 / Q000096:biosynthesis
D010982:Platelet-Derived Growth Factor; D020574:Proto-Oncogene Proteins c-sis; D012155:Reticulin; D053773:Transforming Growth Factor beta1; D000077214:Becaplermin; D003094:Collagen