1.Histopathological Causes of Late Liver Allograft Dysfunction: Analysis at a Single Institution.
Eun SHIN ; Ji Hoon KIM ; Eunsil YU
Korean Journal of Pathology 2013;47(1):21-27
BACKGROUND: We summarize our experience in the pathological diagnosis of late complications of liver transplantation (LT) to better understand the causes of late allograft dysfunction in a population mostly composed of patients with hepatitis B virus (HBV) infection. METHODS: We reviewed 361 post-transplant liver biopsies from 174 patients who underwent LT and first presented with liver function abnormalities 3 months post-procedure. The underlying diseases included HBV-associated liver disease (77%), toxic or alcoholic liver disease (10.3%), hepatitis C virus (HCV)-associated liver disease (8.6%), primary biliary cirrhosis (1.2%), primary sclerosing cholangitis (1.2%), and metabolic disease (1.7%). RESULTS: The three most common late complications were acute rejection (32.5%), recurrent disease (19.1%), and biliary complication (17.1%). Patients who underwent LT for HBV infection or for drug- or alcohol-related liver disease had a lower incidence of recurring disease than those who underwent transplantation for HCV infection. During post-transplantation months 3-12, acute rejection was the most common cause of allograft dysfunction and recurring disease was the leading cause for allograft dysfunction (p=0.039). The two primary causes of late allograft dysfunction have overlapping histological features, although acute rejection more frequently showed bile duct damage and vascular endothelialitis than recurring HBV infection, and recurring HBV infection had more frequent lobular activity and piecemeal necrosis. CONCLUSIONS: The causes of late liver allograft dysfunction are closely associated with the original liver diseases and the period after LT. Careful attention is required for differential diagnosis between acute rejection and recurrent HBV.
Bile Ducts
;
Biopsy
;
Cholangitis, Sclerosing
;
Diagnosis, Differential
;
Hepacivirus
;
Hepatitis B virus
;
Humans
;
Incidence
;
Liver
;
Liver Cirrhosis, Biliary
;
Liver Diseases
;
Liver Diseases, Alcoholic
;
Liver Transplantation
;
Metabolic Diseases
;
Rejection (Psychology)
;
Transplantation, Homologous
;
Transplants
2.Clinicopathologic Analysis of the Liver Explant with Severe Hepatitis A Virus Infection.
Joo Young KIM ; Sung Gyu LEE ; Shin HWANG ; Ji Hoon KIM ; Se Jin JANG ; Eunsil YU
Korean Journal of Pathology 2011;45(Suppl 1):S48-S52
The incidence of severe hepatitis A virus (HAV) infection has been increasing. However, clinicopathologic features of severe HAV infection that lead to liver transplantation (LT) have not been reported in Korea. We retrieved 16 LT cases with HAV infection during the last 3 years at Asan Medical Center, Seoul, Korea. Fifteen cases progressed to hepatic encephalopathy. Thirteen cases survived with or without complications, and three patients died of sepsis. The explanted liver showed massive or zonal necrosis with moderate to severe cholestasis. The zonal distribution of necrosis was frequently associated with endothelialitis of portal and/or central veins. Degenerative changes of hepatocytes were various in degree and distribution. Viral inclusions were suspected in two cases. Although HAV infection is usually confirmed by serological tests, significant venulitis of central and/or portal veins and viral inclusions, which are rarely observed, can suggest an HAV infection as a cause of massive hepatic necrosis of unknown mechanism.
Cholestasis
;
Fluconazole
;
Hepatic Encephalopathy
;
Hepatitis
;
Hepatitis A
;
Hepatitis A virus
;
Hepatocytes
;
Humans
;
Incidence
;
Korea
;
Liver
;
Liver Transplantation
;
Massive Hepatic Necrosis
;
Necrosis
;
Portal Vein
;
Sepsis
;
Serologic Tests
;
Veins
3.Primary Mucinous Cystic Neoplasm of the Retroperitoneum: A Report of Three Cases.
Dong Eun SONG ; Mi Jung KIM ; Shin Kwang SHIN ; Eunsil YU ; Kyung Ja CHO
Korean Journal of Pathology 2003;37(3):204-209
Primary mucinous cystic neoplasms of the retroperitoneum in women are rare and show histologic features similar to their ovarian or pancreatic counterparts. We present three cases of primary retroperitoneal mucinous neoplasms of variable malignant potentials including a cystadenocarcinoma in a 50-year-old woman, a cystic neoplasm of borderline malignancy in a 31-year-old woman, and a cystadenoma in a 67-year-old woman. All cases showed histologic features similar to mucinous tumors of the ovary. Immunohistochemical study demonstrated positivity for calretinin in case 3. The histogenesis of these neoplasms can be assumed most likely to be mucinous metaplasia of the mesothelium or undetected heterotopic pancreatic tissue. Appropriate management is thought to be the same as for analogous ovarian neoplasms.
Adult
;
Aged
;
Calbindin 2
;
Cystadenocarcinoma
;
Cystadenoma
;
Epithelium
;
Female
;
Humans
;
Metaplasia
;
Middle Aged
;
Mucins*
;
Ovarian Neoplasms
;
Ovary
4.Characterization of Histopathological Features that Differentiate Hepatitis B Virus Infection from Acute Cellular Rejection.
Dong Eun SONG ; Dong Hwan JUNG ; Shin HWANG ; Bong Hee PARK ; Eunsil YU
Korean Journal of Pathology 2009;43(6):535-541
BACKGROUND: Differentiation of viral hepatitis from acute cellular rejection (ACR) after liver transplantation can be difficult because of overlapping histological features. Here we investigated clinicopathologic characteristics of 311 liver allograft biopsies and searched for characteristic histopathological features that would facilitate the differential diagnosis between hepatitis B virus (HBV) infection and ACR. METHODS: A retrospective clinicopathologic examination of 311 liver allograft biopsies consisting of clinically proven ACR or HBV infection was performed. Immunohistochemical staining for HBcAg and HBsAg was done for 64 allograft biopsies showing HBV infection. RESULTS: Moderate to severe bile duct damage, diffuse centrilobular necrosis and centrilobular inflammation (p<0.000, for each) were more frequently observed in cases of ACR, whereas diffuse acidophilic bodies and spotty necrosis (p<0.000, for each) were more prevalent in cases of HBV infection. Immunopositivity for HBcAg (n=60, 93.8%) was higher than that for HBsAg (n=14, 21.9%) CONCLUSIONS: The presence of moderate to severe bile duct damage, diffuse centrilobular necrosis and centrilobular inflammation was a characteristic feature of ACR, whereas diffuse distribution of acidophilic bodies or spotty necrosis was the only characteristic feature of HBV infection. HBcAg was a more sensitive immunohistochemical marker than HBsAg for detecting HBV infection in liver allograft biopsies.
Bile Ducts
;
Biopsy
;
Diagnosis, Differential
;
Graft Rejection
;
Hepatitis
;
Hepatitis B
;
Hepatitis B Core Antigens
;
Hepatitis B Surface Antigens
;
Hepatitis B virus
;
Inflammation
;
Liver
;
Liver Transplantation
;
Necrosis
;
Rejection (Psychology)
;
Retrospective Studies
;
Transplantation, Homologous
5.Use of methylene blue in vasoplegic syndrome that developed during non-cardiac surgery: A case report
In Duk OH ; Eunsil SHIN ; Jong Mi JEON ; Hyunho WOO ; Jeong Hyun CHOI
Anesthesia and Pain Medicine 2019;14(4):460-464
BACKGROUND: Vasoplegic syndrome is an increasingly recognized disease in perioperative medicine and is characterized by severe hypotension, normal or elevated cardiac output, and decreased systemic vascular resistance. It occurs commonly after cardiopulmonary bypass but may also occur after other types of surgery.CASE: Vasoplegic syndrome developed in our patient during posterior lumbar interbody fusion because of administering nicardipine after phenylephrine. However, the blood pressure did not increase as expected despite simultaneous use of norepinephrine and vasopressin to increase the reduced systemic vascular resistance.CONCLUSIONS: We present a case of vasoplegic syndrome that developed during posterior lumbar interbody fusion and was treated successfully with methylene blue.
Blood Pressure
;
Cardiac Output
;
Cardiopulmonary Bypass
;
Humans
;
Hypotension
;
Methylene Blue
;
Nicardipine
;
Norepinephrine
;
Phenylephrine
;
Vascular Resistance
;
Vasoplegia
;
Vasopressins
9.Overexpression of C-reactive Protein as a Poor Prognostic Marker of Resectable Hepatocellular Carcinomas.
Jin Ho SHIN ; Chong Jai KIM ; Eun Jeong JEON ; Chang Ohk SUNG ; Hwa Jeong SHIN ; Jene CHOI ; Eunsil YU
Journal of Pathology and Translational Medicine 2015;49(2):105-111
BACKGROUND: C-reactive protein (CRP) is an acute phase reactant synthesized in the liver. CRP immunoreactivity is a feature of inflammatory hepatocellular adenomas with a higher risk of malignant transformation. A high serum CRP level denotes poor prognosis in hepatocellular carcinoma (HCC) patients. This study was conducted to determine whether CRP is produced in HCC and to assess the clinicopathologic significance of CRP expression in cancer cells. METHODS: CRP immunoreactivity was examined in treatment-naive HCCs (n=224) using tissue microarrays and was correlated with clinicopathologic parameters. The expression of CRP mRNA and protein was also assessed in 12 HCC cases by quantitative real-time polymerase chain reaction and immunoblotting. Hep3B and SNU-449 HCC cell lines were used for the analysis of CRP mRNA regulation by interleukin 6 (IL-6). RESULTS: CRP was expressed in 133 of 224 HCCs (59.4%) with a variable degree of immunoreactivity (grade 1 in 25.9%; grade 2 in 20.1%; grade 3 in 13.4%). There was an inverse relationship between grade 3 CRP immunoreactivity and cancer-specific survival (p=.0047), while no associations were found with other parameters, including recurrence-free survival. The CRP mRNA expression level was significantly higher in CRP immunopositive cases than in immunonegative cases (p<.05). CRP mRNA expression was increased in Hep3B cells, but was not detected in SNU-449 cells even after IL-6 treatment. CONCLUSIONS: We report the expression of CRP in HCC for the first time. CRP expression was associated with poor cancer-specific survival in patients with resectable HCC.
Adenoma, Liver Cell
;
C-Reactive Protein*
;
Carcinoma, Hepatocellular*
;
Cell Line
;
Humans
;
Immunoblotting
;
Immunohistochemistry
;
Interleukin-6
;
Liver
;
Prognosis
;
Real-Time Polymerase Chain Reaction
;
RNA, Messenger
10.Expression of Ku Correlates with Radiation Sensitivities in the Head and Neck Cancer Cell Lines.
Sang wook LEE ; Eunsil YU ; So Lyoung YI ; Se Hee SON ; Jong Hoon KIM ; Seung Do AHN ; Seong Soo SHIN ; Eun Kyung CHOI
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2004;22(3):208-216
PURPOSE: DNA-dependent protein kinase (DNA-PK) is a serine/threonine kinase consisting of a 470 kDa catalytic subunit (DNA-PKcs) and a heterodimeric regulatory complex, called Ku, which is composed of 70 kDa (Ku 70) and 86 kDa (Ku 80) proteins. The DNA-PK has been shown to play a pivotal role in rejoining DNA double-strand-breaks (dsb) in mammalian cells. The purpose of this study is to examine the relationship between the level of Ku expression and radiation sensitivity. METHODS AND MATERIALS: Nine head and neck, cancer cell lines showed various intrinsic radiation sensitivities. Among the nine, AMC-HN-3 cell was the most sensitive for X-ray irradiation and AMC-HN-9 cell was the most resistance. The most sensitive and resistant cell lines were selected and the test sensitivity of radiation and expression of Ku were measured. Radiation sensitivity was obtained by colony forming assay and Ku protein expression using Western blot analysis. RESULTS: Ku80 increased expression by radiation, wheres Ku70 did not. Overexpression of Ku80 protein increased radiation resistance in AMC-HN9 cell line. There was a correlation between Ku80 expression and radiation resistance. Ku80 was shown to play an important role in radiation damage response. CONCLUSION: Induction of Ku80 expression had an important role in DNA damage repair by radiation. Ku80 expression may be an effective predictive assay of radiosensitivity on head and neck cancer.
Blotting, Western
;
Catalytic Domain
;
Cell Line*
;
DNA
;
DNA Damage
;
DNA-Activated Protein Kinase
;
Head and Neck Neoplasms*
;
Head*
;
Neck
;
Phosphotransferases
;
Radiation Tolerance*