Sinusoidal Obstruction Syndrome (SOS) in Multiple Myeloma with Renal Failure

Figure 1

Diagnosis of SOS on liver biopsy in case 1, 2, and 3. Case 1. Hematoxylin and eosin-stained section of the liver biopsy shows some portal areas with sparse inflammation comprising predominantly of lymphocytes and rare plasma cells, with fibrous expansion of most portal areas. Bile ducts show mild dystrophy and regenerative changes in some portal tracts. The hepatocyte shows dropout of hepatocytes and acidophilic bodies predominantly involving centrilobular areas with intracanalicular and intrahepatic cholestasis. Case 2. Hematoxylin and eosin-stained section of the liver biopsy shows preserved lobular architecture with patchy fibrosis within sinusoids and marked central venular fibrosis. Portal tracts show mild portal fibrosis and focal ductular reaction. Some of the bile ducts show cytoplasmic vacuolation, disordered nuclear polarity, and occasional mononuclear inflammatory infiltrates within the bile duct epithelium. Case 3. Hematoxylin and eosin-stained section of the liver biopsy shows foci of centrilobular hepatocyte drop-out, cholestasis, and portal areas with ductular reaction. A few central veins show partial to near complete occlusion and pericellular fibrosis.