Hepatic histologic phenotype in malignant hematologic neoplasms

Abstract

Background. Hepatic involvement in malignant hematologic neoplasms is common, yet often underdiagnosed. The spectrum of lesions ranges from minimal changes to acute liver failure, and hepatic histopathological evaluation is essential for the early identification of parenchymal and portal system involvement. Objective(s). To identify hepatic histological features in malignant hematologic neoplasms and correlate them with the specific nosological entities, with the aim of optimizing diagnosis and therapeutic management. Materials and methods. A narrative review of specialized literature published between 2000 and 2024 was conducted, drawing upon 73 sources indexed in major international databases such as PubMed, Medline, MedScape, and Hinari. This review incorporated detailed morphological data concerning non-Hodgkin lymphomas, multiple myeloma, and acute myeloid leukemia. Results. Histological liver alterations are present in approximately 90% of patients with malignant hematologic neoplasms. In non-Hodgkin lymphomas, hepatic involvement affects 15 to 30% of cases and demonstrates three histologic patterns: nodular, sinusoidal, and portal infiltration. Multiple myeloma is characterized by diffuse plasma cell infiltration in portal tracts and sinusoids, along with hepatic amyloidosis found in 10 to 15% of patients. Liver involvement in acute myeloid leukemia is rare, marked histologically by sinusoidal dilation, erythrocyte extravasation, congestion, centrilobular necrosis, and venule occlusion in advanced stages. Conclusion(s). The hepatic histologic profile varies according to the type of hematologic malignancy, reflecting specific mechanisms of involvement. Liver biopsy is essential for differential diagnosis, accurate staging, and guiding appropriate treatment, significantly impacting patient prognosis.