Tusanqirelated sinusoidal obstruction syndrome in china. To describe the ct and mri features of hepatic sinusoidal obstruction syndrome hsos caused by herbal medicine gynura segetum. Hepatic venoocclusive disease harvard catalyst profiles. Hepatic venoocclusive disease radiology reference article. It is the official journal of the new york roentgen society nyrs, published by elsevier, with a 10section table of contents. In vitro and in vivo studies examined changes induced by monocrotaline, a pyrrolizidine alkaloid that induces sinusoidal. Hepatic sinusoidal obstruction syndrome sos, previously termed hepatic venoocclusive disease vod, is one of the most feared complications of allogeneic and autologous hematopoietic cell transplantation hct. This study aimed to assess computed tomography scan ctscan performance for sos diagnosis for patients receiving neoadjuvant chemotherapy nc prior to crlm surgery, comparing obtained results with pathological gold standard.
Sos is often established clinically, based on baltimore, modified seattle, or european society for blood and marrow transplantation ebmt criteria. Transabdominal ultrasonography us enables the visualization of blood flow abnormalities and is therefore useful for the diagnosis of sosvod. Toxic agent damages sinusoidal endothelial cells, likely via depletion of glutathione and nitric oxide injury related sloughing of sinusoidal endothelial cells leads to embolic sinusoidal obstruction around central veins hepatocytes also injured, contributing to disease process. Apr 10, 2015 oxaliplatin based chemotherapy is often used as adjuvant therapy in colon and rectal cancer or in perioperative therapy in liver metastatic disease 1,2. Sinusoidal obstruction syndrome venoocclusive disease. The spectrum of histologic findings in hepatic outflow. Sinusoidal obstruction syndrome soshepatic venoocclusive disease vod is a welldocumented complication after hematopoietic stem cell transplantation hsct. Hepatic venoocclusive disease or venoocclusive disease with immunodeficiency vodi is a condition in which some of the small veins in the liver are obstructed. Hepatic venoocclusive disease vod, increasingly referred to as sinusoidal obstruction syndrome, is a wellrecognized complication of hematopoietic stem cell transplantation and contributes to considerable morbidity and mortality.
The ct and mri features of 16 consecutive gynura segetum induced. Diagnosis of sinusoidal obstruction syndrome by positron emission tomographycomputed tomography. Hepatic venoocclusive disease sinusoidal obstruction. Mar 07, 2014 hepatic sinusoidal obstruction syndrome is associated with considerable mortality due to the severity of the disease and the absence of effective therapy. Hepatic sinusoidal obstruction syndrome caused by herbal. Hepatic venoocclusive disease is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. Chemotherapyinduced focal hepatopathy in patients with. However, we have encountered several cases in which nontumorous. Most of the imaging modalities used to assess the spleen have certain disadvantages in providing accurate volume estimations of the spleen. Sinusoidal obstruction syndrome venoocclusive disease in. A disruption in the normal flow of venous blood from the sinusoids of the liver and the hepatic venules. Rat sos models of various severities were created by monocrotaline gavage n 40 or by intraperitoneal injection of 5fluorouracil, leucovorin and oxaliplatin folfox n 16. Impact of bevacizumab on parenchymal damage and functional. The reported overall incidence rate of venoocclusive disease ranges from 5% to more than 60% i.
Noninvasive assessment of hepatic sinusoidal obstructive. It is a complication of highdose chemotherapy given before a bone marrow transplant bmt and is marked by weight gain due to fluid retention, increased liver size, and raised levels of bilirubin in the blood. Inotuzumab is a calicheamicinconjugated cd22 targeting antibody. Sos can present in an acute, subacute or chronic form usually with abdominal pain and swelling, with evidence of portal hypertension and variable degrees of serum enzyme elevations and jaundice. Sinusoidal obstruction syndrome hepatic venoocclusive. Hepatic venoocclusive disease hvod, also termed hepatic sinusoidal obstruction syndrome, is a rare clinical syndrome caused by several factors including highdose chemotherapy before haematopoietic stem cell transplantation hsct 1, 2, highdose chemotherapy and ingestion of herbal compounds containing pyrrolizidine alkaloids pas. Jul 11, 2008 we present the case of a patient with colon cancer who, while receiving bevacizumab, developed sinusoidal obstruction syndrome venoocclusive disease sosvod.
March 31, 2020 a brief article from henry ford health system in detroit, published today in radiology, reports on the first presumptive case of covid19associated acute necrotizing hemorrhagic encephalopathy. We introduce sinusoidal ghost imaging sgi, which uses 2d orthogonal sinusoidal patterns instead of random patterns in computational ghost imaging cgi. Sinusoidal obstruction syndrome sos, formerly named venoocclusive disease, is a wellknown complication of hematopoietic stem cell transplantation and ingestion of food or drinks contaminated by. Certain antitumour agents such as 6mercaptopurine and 6thioguanine have also been reported to initiate hepatic sosvod in isolated cases. Successful treatment of severe sinusoidal obstruction. May 24, 2018 sinusoidal obstruction syndrome soshepatic venoocclusive disease vod is a welldocumented complication after hematopoietic stem cell transplantation hsct. The diagnosis is based on clinical criteria supported by imaging studies, while defibrotide is the mainstay of therapy. Hepatic venoocclusive disease vod, also known as sinusoidal obstruction syndrome sos, is a condition arising from occlusion of hepatic venules. Of note, sinusoidal obstruction syndrome follows a different pathophysiologic mechanism than buddchiari and cardiac hepatopathy, as the sinusoidal endothelium itself becomes damaged. The change in the nomenclature of this disease is primarily because the major lesion is located at the hepatic sinusoids.
This results in a mottled pattern of contrast enhancement in the arterial and early portal venous phase with decreased enhancement of the liver periphery. The liver is the most common metastatic site of colorectal cancer, and it is known that approximately 25% of the. Sinusoidal obstruction syndrome hepatic venoocclusive disease. When hepatic veins are congested, contrast is prevented from diffusing through the liver in a normal manner. A nutmeg liver appearance is due to a perfusion abnormality of the liver usually as result of hepatic venous congestion. A noninvasive diagnostic approach using perrectal portal.
Sinusoidal obstruction syndrome sos is a rare liver vascular injury disease, characterized by damage to small hepatic vessels, affecting particularly the sinusoidal endothelium, which result in complications such as intrahepatic congestion, liver damage, and portal hypertension. Paradoxical patterns of sinusoidal obstruction syndrome. Sos, also known as venoocclusive disease vod, occurs as a result of cytoreductive. We report a case of sinusoidal obstruction syndrome, a typical and lifethreatening complication after allogeneic stemcell transplantation, successfully treated with defibrotide despite massive multiple organ failure. Nov 29, 2016 hepatic sinusoidal obstruction syndrome hsos also named venoocclusive disease or vod is defined as a nonthrombotic obstruction of the sinusoids without thrombosis or other underlying. This metaanalysis evaluates the impact of bevacizumab on parenchymal damage and functional recovery in patients undergoing resection for clm. Revised diagnosis and severity criteria for sinusoidal obstruction syndromeveno occlusive disease in adult patients. Sinusoidal obstruction syndrome venoocclusive disease in a. Hepatic sinusoidal obstruction syndrome sos, formerly known as venoocclusive disease vod, is a syndrome of tender hepatomegaly, weight gain, ascites, fluid retention, and hyperbilirubinemia caused by toxic liver injury. Hepatic parenchymal heterogeneity as a marker for oxaliplatin.
Sinusoidal obstruction syndrome sos is a rare liver disorder due to hepatic vascular injury. Sinusoidal obstruction syndrome, previously known as venoocclusive disease, is a distinctive and potentially fatal form of hepatic injury that occurs predominantly, if not only, after drug or toxin exposure. Its rapid and accurate diagnosis is crucial for patient survival. Hepatic sinusoidal obstruction syndrome hsos, the new name given to venoocclusive disease vod of the liver, is a wellknown complication of highdose chemotherapy employed with hematopoietic stem cell transplantation, but it has rarely been observed in children who receive conventional chemotherapy. Oxaliplatin based chemotherapy is often used as adjuvant therapy in colon and rectal cancer or in perioperative therapy in liver metastatic disease 1,2.
Hepatic sinusoidal obstruction syndrome hsos, formerly called hepatic venoocclusive disease, is a rare yet lifethreatening clinical syndrome characterized by painful hepatomegaly, ascites and hyperbilirubinemia. The biochemical changes that permit the dehiscence of the sinusoidal endothelial cells were investigated. Noninvasive imaging diagnosis of sinusoidal obstruction. Aug 23, 2009 hepatic sinusoidal obstruction syndrome hsos, the new name given to venoocclusive disease vod of the liver, is a wellknown complication of highdose chemotherapy employed with hematopoietic stem cell transplantation, but it has rarely been observed in children who receive conventional chemotherapy. Correlation with treatment response of colorectal cancer liver metastases na yeon han 1, beom jin park 1, kyung sook yang 2, min ju kim 1, deuk jae sung 1, ki choon sim 1 and sung bum cho 1. Sinusoidal obstruction syndrome sos is a potentially lifethreatening complication of allogeneic hematopoietic stem cell transplantation hsct.
Discerning sinusoidal obstruction syndrome venoocclusive. Supportive care is the mainstay of therapy for mild and moderate sinusoidal obstruction syndrome. Little is known about the safety of the antivegf antibody bevacizumab in patients undergoing resection for colorectal liver metastases clm. In the western hemisphere, vod, classified as a conditioningrelated toxicity, is most commonly caused.
Sinusoidal obstruction syndrome europe pmc article. It is recommended that the diagnosis of venoocclusive disease sinusoidal obstruction syndrome vod sos be based primarily on established clinical criteria modifi. Paradoxical patterns of sinusoidal obstruction syndromelike. The overall mortality from hsos varies from 3% to 67% in different series 26, 27. This disease was first described in 1920 in association with the ingestion of senecio tea containing natural toxin pyrrolizidine alkaloids pas. Hepatic sinusoidal obstruction syndrome sos, previously termed hepatic venoocclusive disease vod, is characterized by hepatomegaly, right upper quadrant pain, jaundice, and ascites, most often occurring in patients undergoing hematopoietic cell transplantation hct and less commonly following the use of certain chemotherapeutic agents in nontransplant settings, ingestion. Sinusoidal obstruction syndrome sos is a likely side effect of colorectal liver metastases crlm chemotherapy. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Risk factors for hepatic venoocclusive disease caused by. Hepatic parenchymal heterogeneity as a marker for oxaliplatininduced sinusoidal obstruction syndrome. Symptoms include hyperbilirubinemia, painful hepatomegaly and ascites. Pdf hepatic sinusoidal obstruction syndrome caused by.
Pathology outlines sinusoidal obstruction syndrome. Along with graft versus host disease gvhd and cytomegalovirus cmv infection, venoocclusive disease vod or sinusoidal obstruction syndrome sos, is one of the most frequently encountered serious complications after stem cell transplantation. Sinusoidal obstruction syndrome how is sinusoidal obstruction syndrome abbreviated. The mechanical origins of the obstruction in sinusoidal obstruction syndrome are initiated by dehiscence of sinusoidal endothelial cells from the space of disse. It accounts for a significant fraction of transplantrelated mortality and, in its severe form, is almost always fatal. Sinusoidal obstruction syndrome sos is a rare vascular disease of the liver, which can lead to lethal liver failure and portal hypertensionrelated complications. Sinusoidal obstruction syndrome definition of sinusoidal.
In comparison with thedifferential ghost imaging algorithm that was used to improve the snr of ghost imaging, results of sgi show about 3 orders of magnitude higher snr, which can be. To determine the feasibility of acoustic radiation force impulse arfi elastography in the evaluation of hepatic sinusoidal obstruction syndrome sos in rat models. The calicheamicin component of the drug is likely associated with the hepatotoxicity seen with inotuzumab, especially sinusoidal obstruction syndrome, which can happen both in the context of the drug alone, and also with allogeneic stem cell transplantation. Diagnosis of sinusoidal obstruction syndrome by positron. It occurs primarily after hematopoietic stem cell transplantation and is characterized by enlargement of the liver, right upper quadrant pain, jaundice, and massive fluid retention in the peritoneum. Sinusoidal obstruction syndrome sos, formerly named venoocclusive disease, is a wellknown complication of hematopoietic stem cell transplantation and ingestion of. A reported side effect is sinusoidal obstruction syndrome sos, formerly known as venoocclusive disease, which is characterized by a spectrum of pathologic changes, from sinusoidal dilation, peri sinusoidal haemorrhage, peliosis and nodular. Diagnostic performance of contrastenhanced ctscan in. It occurs primarily after hematopoietic stem cell transplantation and is characterized by enlargement of the liver, right upper quadrant pain, jaundice, and massive fluid retention in the. A 64yearold caucasian woman underwent allogeneic peripheral blood stemcell transplantation from her human leukocyte antigenidentical sister against aggressive. Mar 31, 2016 along with graft versus host disease gvhd and cytomegalovirus cmv infection, venoocclusive disease vod or sinusoidal obstruction syndrome sos, is one of the most frequently encountered serious complications after stem cell transplantation. The severe form of sinusoidal obstruction syndrome needs defibrotide thrombolytic agent along with supportive care.
Hepatic sinusoidal obstruction syndrome in a child after. A noninvasive diagnostic approach using perrectal portal scintigraphy for sinusoidal obstruction syndrome after allogeneic hematopoietic cell transplantation. Radiology publishes first case of covid19 encephalopathy. Management of toxicities associated with novel immunotherapy. Hepatic venoocclusive disease sinusoidal obstruction syndrome.
This is thought to be due to liver sinusoidal injury, which presents with histopathological changes similar to the changes seen in the sinusoidal obstruction syndrome. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. Although the pathogenesis of oxaliplatin related sinusoidal obstructive syndrome is not fully understood, studies suggest it is. Noninvasive imaging diagnosis of sinusoidal obstruction syndrome. Hepatic sinusoidal obstruction syndrome hsos also named venoocclusive disease or vod is defined as a nonthrombotic obstruction of the sinusoids without thrombosis or other underlying. Oxaliplatin toxicity presenting as a liver nodule case. Full text increase in spleen volume as a predictor of. Reported patterns of chemotherapyinduced hepatopathy of nontumorbearing hepatic parenchyma include steatosis, steatohepatitis, and sinusoidal obstruction syndrome sos, which usually manifest as diffuse involvement of the liver, with risk of functional problems 3, 6, 8. The management of sinusoidal obstruction syndrome depends on the severity of the disease. Imaging of pathology involving the space around the hepatic veins. We present the case of a patient with colon cancer who, while receiving bevacizumab, developed sinusoidal obstruction syndrome venoocclusive disease sosvod.
Hepatic sinusoidal obstruction syndrome sos is an obliterative venulitis of the terminal hepatic venules, which in its more severe forms imparts a high risk of mortality. Jan 25, 2019 sinusoidal obstruction syndrome sos is a potentially lifethreatening complication of allogeneic hematopoietic stem cell transplantation hsct. There have been no reports so far correlating bevacizumab with sosvod. The reported overall incidence rate of venoocclusive disease ranges from 5% to more than 60% in. The medline, embase and cochrane library were systematically searched for studies on preoperative. Clinical presentation right upper quadrant pain painful hepatomegaly ascites abnormal liver. Hepatic sinusoidal obstruction syndrome sos, previously termed hepatic venoocclusive disease vod, is characterized by hepatomegaly, right upper quadrant pain, jaundice, and ascites, most often occurring in patients undergoing hematopoietic cell transplantation hct and less commonly following the use of certain chemotherapeutic agents in nontransplant settings, ingestion of alkaloid toxins, after high dose radiation therapy, or liver transplantation. Oct 30, 2014 hepatic sinusoidal obstruction syndrome sos is an obliterative venulitis of the terminal hepatic venules, which in its more severe forms imparts a high risk of mortality. Assessment of the proposed ebmt pediatric criteria for. Novel ultrasonographic scoring system of sinusoidal. Colorectal cancer is one of the most common causes of cancerrelated mortalities, and it is the third most commonly diagnosed cancer in men and the second in women, with more than 1.
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