PMC1299324_01
Intracytoplasmic inclusions with ground-glass appearance affecting most of the hepatocytes in this area. Mononuclear inflammatory infiltrate in a portal area is also seen. Hematoxylin-eosin, x40. Inset: Higher magnification of this area, (H&E, x200).
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F1
However, the most remarkable finding was the presence of abundant intracytoplasmic, sharply bordered, pale eosinophilic inclusions that exhibited a ground-glass appearance (Figure 1).
Strong and diffuse immunohistochemical positivity of the inclusions for fibrinogen, x40. Inset: Same area with higher magnification. (x200).
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F2
Diffuse and strong positivity was observed for fibrinogen in cytoplasmic inclusions (Figure 2).
On ultrastructure, inclusions appear as finely granular, homogeneous material bounded by membranes (arrows). x4400
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F3
Ultrastructurally, the inclusions were found to be moderately electron-dense, finely granular, homogenous bodies that are encircled by membranes, corresponding to a dilated endoplasmic reticulum (Figure 3).
In the second biopsy, inclusions and chronic hepatitic changes are dramatically reduced, (H&E, x200).
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F4
Parenchymal and portal inflammation, steatosis and necroinflammatory activity were remarkably reduced in the second liver biopsy (Figure 4).