PMC4748189_01
Liver biopsies before diagnosis of ALCL. (A) Bile duct damage is appreciated in a background of minimal inflammatory infiltration (arrow). (B) Arrow indicates hepatic arteriole and arrowhead points to portal venule without the presence of interlobular bile duct. (C) Cholestasis and hepatocyte injury are present predominately in the perivenular region (arrow).
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F1
Liver biopsy revealed bile duct damage, cholestasis, and hepatocyte injury (Figure 1).
Liver biopsies 10 weeks after diagnosis of ALCL and chemotherapy. Arrow indicates hepatic arteriole and arrowhead indicates portal venule. (A) Complete loss of bile duct resulting in ductopenia. (B) CK7 staining confirms the complete absence of bile duct. (C) Arrow indicates severe cholestasis and perivenular hepatocyte injury.
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F2
However, his jaundice and pruritus worsened, and a repeat liver biopsy demonstrated the complete loss of intrahepatic bile ducts, compatible with vanishing bile duct syndrome (VBDS; Figure 2).