Pathology: sinusoidal obstruction syndrome

Veno-occlusive disease (VOD) also called sinusoidal obstruction syndrome (SOS) typically occurs within 21 days of an allogenic, hematopoietic stem cell transplant.  These patients may have markedly elevated LFT, and frequently develop ascites because of increased sinusoidal pressures resulting from outflow obstruction.  In this clinical setting, liver biopsy is not necessary, however, biopsies are associated with findings of:

reticulin deposition within sinusoids, central vein occlusion, hepatocyte atrophy/necrosis, sinusoidal/perivenular hemorrhage and sparing of portal tracts.  In the histologic specimen above, be impressed with the fully thrombosed central vein in Zone 3 (right side of specimen). 

In some instances, this diagnosis is made after the typical 3 week window period.  In the manuscript link below, 8 such cases are described; diagnosis was made at a mean of 52 days.  A risk factor for development of SOS in these cases was the use of high-dose busulfan. 

http://www.ncbi.nlm.nih.gov/pubmed/22280517

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