Fig. 4

The Second Liver-Biopsy Specimens on Day 213. The second liver biopsy indicated again the absence of small terminal bile ducts. The specimen shows six peri-portal areas and lobular plates were intact. Hepatic lobule scattered with focal moderate necrosis and small granuloma formation. The cytoplasm of hepatocytes was loose with eosinophilic changes and inflammatory infiltration around central veins. There were mild sinusoidal expansion with a small amount of sinus lymphocytes and eosinophil infiltration. There were bile duct injuries, a loss of bile duct structure around central arteries with visible lymphocytes, and a small amount of plasma cell infiltration. In addition, there was mild interface inflammation, interstitial fibrous tissue hyperplasia, and peripheral hepatocyte bile salt deposition. Immuno-histochemical stains were positive for CD10, CD38, CK19, CK7, Mum-1, Masson, and Copper-rhodanine. However, the stains were negative for HBcAg, HBsAg, PRE-S1, ubiquitin, D-pas, PAS, and iron. Ishak grading:necroinflammatory activity score of 4 and fibrosis score of 2. There are four panels inside the image of Fig. 4 including panel A for the specimen with hematoxylin and eosin stain (manification x 10), panel B for the specimen with Masson stain (manification x 10), panel C for the specimen with hematoxylin and eosin stain (magnification x 40), and panel D for the specimen with CK-7 stain (magnification x10)