PMC517503_01
A: Serum Bilirubin levels (mumol/L) for patient 1 (solid line) and for patient 2 (dashed line). The arrowheads indicate the time points where calcifications were detected. B: International Normalization Ratio (INR) for patient 1 (solid line) and for patient 2 (dashed line). Arrowheads indicate the time points where calcifications were detected. C: Computed Tomography of patient 2. The arrow points an area in the right liver with the same density as the spinal column (arrowhead). D: Picture of the explant liver during retransplantation of the same patient (case 2). The arrow shows the abnormal area of the right liver correlating with the computed tomography findings. E: Light microscopy of epoxy embedded semi-section obtained from the liver biopsy from patient 1. The image shows moderate calcification (microcalcification) throughout the section. The arrow indicates a representative pattern of calcification. F: Light microscopy of epoxy embedded semi-section obtained from the tissues of the explant, following liver retransplantation of patient 2. The image shows the interface between calcified region (upper right) and non-calcified adjacent hepatic cells (lower left region). G: Light microscopy image showing a higher magnification of calcified region as shown in F. The bright and high contrast regions represent massive mineralization of hepatic cells of the explant, following retransplantation. H: Transmission electron microscopy images of ultrathin section obtained from the transitional zone between calcified and non-calcified tissue. Showing the mode of calcification and textural organization of hydroxyapatite crystal aggregates (dark contrast) within cytoplasmic region of the cell. Note alteration of the nucleus in the center.
1471-2482-4-9-1.jpg
PMC517503_02_1471-2482-4-9-1.jpg
F1
Tomography (CT) showed areas in the right lobe of the liver isodense with the spinal column (Figure 1C). The patient was listed for retransplantation. Cross-sections of the right lobe showed a "clay-like" parenchyma with clear evidence of calcification (Figure 1D). Light (LM) and transmission electron microscopy (TEM) investigation of ultrathin sections obtained from specimens selected from biopsies at the interface of calcified and non-calcified tissues showed extensive intracellular calcification within the hepatic cells (Figure 1F). TEM (HRTEM) images and selected-area electron diffraction (SAED) combined with energy dispersive spectroscopy (EDS) analysis demonstrated the presence of hydroxyapatite (HA) as a solid phase in the calcified region. The adjacent non- or partially calcified hepatic cells displayed extensive nuclear condensation suggestive of significant apoptosis as well as severe vacuolization, suggestive of an extensive apoptotic and necrotic process (Figure 1G,1H).
PMC517503_02
A: Serum Bilirubin levels (mumol/L) for patient 1 (solid line) and for patient 2 (dashed line). The arrowheads indicate the time points where calcifications were detected. B: International Normalization Ratio (INR) for patient 1 (solid line) and for patient 2 (dashed line). Arrowheads indicate the time points where calcifications were detected. C: Computed Tomography of patient 2. The arrow points an area in the right liver with the same density as the spinal column (arrowhead). D: Picture of the explant liver during retransplantation of the same patient (case 2). The arrow shows the abnormal area of the right liver correlating with the computed tomography findings. E: Light microscopy of epoxy embedded semi-section obtained from the liver biopsy from patient 1. The image shows moderate calcification (microcalcification) throughout the section. The arrow indicates a representative pattern of calcification. F: Light microscopy of epoxy embedded semi-section obtained from the tissues of the explant, following liver retransplantation of patient 2. The image shows the interface between calcified region (upper right) and non-calcified adjacent hepatic cells (lower left region). G: Light microscopy image showing a higher magnification of calcified region as shown in F. The bright and high contrast regions represent massive mineralization of hepatic cells of the explant, following retransplantation. H: Transmission electron microscopy images of ultrathin section obtained from the transitional zone between calcified and non-calcified tissue. Showing the mode of calcification and textural organization of hydroxyapatite crystal aggregates (dark contrast) within cytoplasmic region of the cell. Note alteration of the nucleus in the center.
1471-2482-4-9-1.jpg
PMC517503_02_1471-2482-4-9-1.jpg
F1
Tomography (CT) showed areas in the right lobe of the liver isodense with the spinal column (Figure 1C). The patient was listed for retransplantation. Cross-sections of the right lobe showed a "clay-like" parenchyma with clear evidence of calcification (Figure 1D). Light (LM) and transmission electron microscopy (TEM) investigation of ultrathin sections obtained from specimens selected from biopsies at the interface of calcified and non-calcified tissues showed extensive intracellular calcification within the hepatic cells (Figure 1F). TEM (HRTEM) images and selected-area electron diffraction (SAED) combined with energy dispersive spectroscopy (EDS) analysis demonstrated the presence of hydroxyapatite (HA) as a solid phase in the calcified region. The adjacent non- or partially calcified hepatic cells displayed extensive nuclear condensation suggestive of significant apoptosis as well as severe vacuolization, suggestive of an extensive apoptotic and necrotic process (Figure 1G,1H).