Sinusoidal obstruction syndrome pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]


The development of sinusoidal obstruction syndrome begins with the injury to hepatic venous endothelium. It is thought that preexisting liver disease increases the risk of developing sinusoidal obstruction syndrome (SOS) due to impairment of drug metabolism which predisposes to the endothelial injury. The endothelial cells in patients with hepatitis may have abnormal expression of adhesion molecules and pro-coagulant factors. The deposition of fibrinogen and factor VIII within the sinusoids leads to their dilation and congestion by erythrocytes. The progressive occlusion of venules leads to widespread zonal liver disruption and centrilobular hemorrhagic necrosis. Hepatic sinusoidal obstruction syndrome (SOS) is mainly seen in patients of hematopoietic cell transplantation.


Originally by Frevert U, Engelmann S, Zougbédé S, Stange J, Ng B, et al

Gross Pathology

  • On gross pathology, the liver has diffusely mottled appearance with areas of congestion and normal appearing hepatic parenchyma.[1]

Microscopic Pathology

The most important histopathological characteristics of sinusoidal obstruction syndrome are:[2][3][4]


  1. Seo AN, Kim H (2014). "Sinusoidal obstruction syndrome after oxaliplatin-based chemotherapy". Clin Mol Hepatol. 20 (1): 81–4. doi:10.3350/cmh.2014.20.1.81. PMC 3992335. PMID 24757663.
  2. McDonald GB, Sharma P, Matthews DE, Shulman HM, Thomas ED (1984). "Venocclusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors". Hepatology. 4 (1): 116–22. PMID 6363247.
  3. Shulman HM, Gown AM, Nugent DJ (1987). "Hepatic veno-occlusive disease after bone marrow transplantation. Immunohistochemical identification of the material within occluded central venules". Am. J. Pathol. 127 (3): 549–58. PMC 1899766. PMID 2438942.
  4. Shulman HM, Fisher LB, Schoch HG, Henne KW, McDonald GB (1994). "Veno-occlusive disease of the liver after marrow transplantation: histological correlates of clinical signs and symptoms". Hepatology. 19 (5): 1171–81. PMID 8175139.

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