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

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Kuroda N, Mizobuchi M, Shimamura Y, Daibata M, Miyoshi I, Ohara M, Hirouchi T, Mizuno K, Lee GH. Bridging necrosis and reticulin bridging fibrosis induced by intrahepatic involvement of acute biphenotypic leukaemia. APMIS 2006;114:908–11.

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.
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Keywords: Acute biphenotypic leukemia; collagen fiber; liver fibrosis; reticulin fiber

Document Type: Research Article

Affiliations: 1: Internal Medicine, Kochi Red Cross Hospital, Kochi, and Departments of 2: Internal Medicine and 3: Pathology and Laboratory Medicine, and 4: Pathology, Kochi Medical School, Kochi University, Kochi, Japan

Publication date: 2006-12-01

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