Bridging necrosis and reticulin bridging fibrosis induced by intrahepatic involvement of acute biphenotypic leukemia

• Published in: APMIS : acta pathologica, microbiologica et immunologica Scandinavica Vol. 114; no. 12; pp. 908 - 911
• Main Authors: KURODA, N., MIZOBUCHI, M., SHIMAMURA, Y., DAIBATA, M., MIYOSHI, I., OHARA, M., HIROUCHI, T., MIZUNO, K., LEE, G. H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2006; Blackwell
• Subjects: Acute biphenotypic leukemia; Biological and medical sciences; Collagen - metabolism; collagen fiber; Fatal Outcome; Female; Fundamental and applied biological sciences. Psychology; Humans; Immunohistochemistry; Infectious diseases; Leukemia, Myeloid, Acute - metabolism; Leukemia, Myeloid, Acute - pathology; Liver Cirrhosis - metabolism; Liver Cirrhosis - pathology; liver fibrosis; Medical sciences; Microbiology; Middle Aged; Necrosis; Platelet-Derived Growth Factor - biosynthesis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - metabolism; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology; Proto-Oncogene Proteins c-sis; Reticulin - metabolism; reticulin fiber; Transforming Growth Factor beta1 - biosynthesis; Hepatic fibrosis; Microbiology; Glycoprotein; reticulin fiber; Acute leukemia; Hepatic disease; collagen fiber; Necrosis; Acute biphenotypic leukemia; liver fibrosis; Immunology; Collagen; Digestive diseases
• ISSN: 0903-4641; 1600-0463
• DOI: 10.1111/j.1600-0463.2006.apm_540.x

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‐β1 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.