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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Isolated hepatic non-obstructive sinusoidal dilatation, 20-year single center experience
Dharma Budi Sunjaya, Guilherme Piovezani Ramos, Manuel Bonfim Braga Neto, Ryan Lennon, Taofic Mounajjed, Vijay Shah, Patrick Sequeira Kamath, Douglas Alano Simonetto
Dharma Budi Sunjaya, Guilherme Piovezani Ramos, Manuel Bonfim Braga Neto, School of Graduate Medical Education, Mayo Clinic, Rochester, MN 55905, United States
Ryan Lennon, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, United States
Taofic Mounajjed, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
Vijay Shah, Patrick Sequeira Kamath, Douglas Alano Simonetto, Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Sunjaya DB contributed to study design, data collection, analysis, drafting, and critical review of the manuscript; Ramos GP contributed to study design, data collection; Braga Neto MB contributed to study design, data collection; Mounajjed T contributed to analysis and critical review of manuscript; Shah V contributed to analysis and critical review of manuscript; Kamath PS contributed to the study design, analysis, and critical review of manuscript; Simonetto DA contributed to study design, data-collection, analysis, drafting of manuscript, and critical review of manuscript.
Institutional review board statement: The study was reviewed and approved by the Mayo Clinic Institutional Review Board.
Informed consent statement: Minimal risk study, waiver of informed consent applied.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Douglas Alano Simonetto, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
simonetto.douglas@mayo.edu
Telephone: +1-480-3018000
Received: January 29, 2018
Peer-review started: February 3, 2018
First decision: March 8, 2018
Revised: April 23, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: May 27, 2018
Processing time: 114 Days and 4 Hours
AIM
To characterize isolated non-obstructive sinusoidal dilatation (SD) by identifying associated conditions, laboratory findings, and histological patterns.
METHODS
Retrospectively reviewed 491 patients with SD between 1995 and 2015. Patients with obstruction at the level of the small/large hepatic veins, portal veins, or right-sided heart failure were excluded along with history of cirrhosis, hepatic malignancy, liver transplant, or absence of electrocardiogram/cardiac echocardiogram. Liver histology was reviewed for extent of SD, fibrosis, red blood cell extravasation, nodular regenerative hyperplasia, hepatic peliosis, and hepatocellular plate atrophy (HPA).
RESULTS
We identified 88 patients with non-obstructive SD. Inflammatory conditions (32%) were the most common cause. The most common pattern of liver abnormalities was cholestatic (76%). Majority (78%) had localized SD to Zone III. Medication-related SD had higher proportion of portal hypertension (53%), ascites (58%), and median AST (113 U/L) and ALT (90 U/L) levels. Nineteen patients in our study died within one-year after diagnosis of SD, majority from complications related to underlying diseases.
CONCLUSION
Significant proportion of SD and HPA exist without impaired hepatic venous outflow. Isolated SD on liver biopsy, in the absence of congestive hepatopathy, requires further evaluation and portal hypertension should be rule out.
Core tip: We identified 88 patients with diagnosis of non-obstructive sinusoidal dilatation (SD) over the period of twenty years. Inflammatory conditions (32%) were the most common cause identified. Medication related SD was associated with higher proportion of portal hypertension, ascites, and elevated transaminases. The finding of non-obstructive SD on liver biopsy should prompt a review of patient’s medical history and drug exposure. Additionally, portal hypertension should be rule out either clinically, endoscopically, or radiographically. There does not appear to be any relationship between histological patterns and medical conditions, which may suggest overlapping biological pathways in the development of non-obstructive sinusoidal dilatation.
