hepatic veno-occlusive disease
Image Gallery
Definition: Hepatic VOD consists of occlusive fibrosis of small intrahepatc veins: centrilobular and sublobular venules. Lager veins and those affected by Budd-Chiari syndrome are spared.
Synopsis
diffuse occlusive lesions of central veins
- central vein stenosis
- fibrous intimal thickening, concentric intimal thickening
- severe centrilobular necrosis, centrilobular hemorrhagic necrosis, hepatocyte dropout
- centrilobular sinusoidal dilatation (congestion)
- sinusoidal hemorrhage
- obliterative fibrosis
- pericentral fibrosis (perivenular fibrosis)
diffuse occlusive lesions of portal veins
Evolutive forms
Early lesions
- subendothelial edema
- centrolobular congestion of the pericentral sinusoids
- blockage of blood flow in the pericentral sinusoids by fibrin and platelet aggregates
- pericentral sinusoids plugged with fibrin, fibrin deposition
- sinusoidal dilatation
- centrilobular hemorrhagic necrosis
late lesions
- intraluminal fibrosis
- concentric intimal thickening
- occlusive fibrosis of small intrahepatic veins (centrolobular veins and sublobular venules), fibrous obliteration of hepatic veins
- concentric occlusion of the affected veins by loose connective tissue
- fibrotic scar replacing the centrilobular vein
- centrolobular fibrosis
- centro-portal bridging
- cirrhosis
Etiology
bone marrow allograft conditioning (BMA-VOD)
- stem cell transplantation (16773513)
- onset of the disorder : 3-4 weeks after transplantation
- frequency: 20% of cases
- mortality rate: 50%
- etiology: cyclophosphamide, alkalating agents, total body irradiation
irradiation (10 Gy of irradiation with chemotherapy; 30Gy without chemotherapy)
antineoplastic drugs
- azathioprine (may cause the lesion many months after continuous administration)
- 6-mercaptopurine
- 6-thioguanine
- mitomycin C
- BCNU(carmustine)
- vincristine
- adriamycin
- intraarterial 5-FU (2531719)
- mitomycine C (6806170)
- gemtuzumab
liver allograft (1.9%) (12640317, 11602848, 8276346, 10534334)
- strong association with acute rejection (mortality: 63%) (10534334)
pyrrolizidine alkaloids
- found in about 300 species of plants
- examples: Heliotropium , Crotolaria and Senecio (Senescia sp.)
- herbal teas and enemas
- chinese palatable local dishes (17075995)
alcoholic liver
congenital immunodeficiency
dimethylnitrosamine
oral contraceptives (estrogenic steroids) (992650)
anabolic steroids
aflatoxin
Variants
fetal hepatic veno-occlusive disease (12835579)
- pyrrolizidine alkaloids of food origin
See also
veno-occlusive lesions
veno-occlusive diseases
bone marrow allograft vasculopathies (BMA vasculopathies)
veno-occlusive disease (VOD)
- liver allograft VOD
- pulmonary VOD (pulmonary veno-occlusive disease)
Case records