PMC4405082_01
Ill-defined soft tissue density within the porta hepatis surrounding the pancreatic head, celiac axis, and common hepatic artery (A); multiple hypodense lesions within the liver and spleen (B), as seen on computed tomography.
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A, B, and C), antinuclear antibody, anti-smooth muscle antibody, anti-liver-kidney microsomal antibodies, anti-mitochondrial antibody were negative. A computed tomography (CT) scan of the abdomen showed cholelithiasis, an ill-defined soft tissue density within the porta hepatis surrounding the pancreatic head, celiac axis, and common hepatic artery (Fig. 1A), along with multiple hypodense lesions within the liver and spleen (Fig. 1B).
Metallic CBD stent filled with sludge (A); occlusion cholangiogram showing normal-looking biliary tree (B).
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The CBD was cannulated through the biliary stent and balloon sweeps were performed with removal of sludge (Fig. 2A). A subsequent occlusion cholangiogram did not reveal any intrahepatic biliary strictures or dilation (Fig. 2B).
Multiple, discrete pale-colored well-circumscribed hepatic lesions seen during laparoscopy (A); biopsy specimen showing nonnecrotizing granuloma with epitheloid cells, multinucleated giant cells, and lymphocytes (40x magnification) (B); Masson's trichrome stain of the biopsy specimen showing perivenular congestion and fibrosis (40x magnification) (C).
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Laparoscopy revealed multiple, discrete pale-colored well-circumscribed lesions in the hepatic parenchyma (Fig. 3A). The biopsy specimen revealed numerous nonnecrotizing granulomas with epitheloid cells, multinucleated giant cells, and lymphocytes (Fig. 3B). Significant perivenular (zone 3) congestion and fibrosis were seen again (Fig. 3C).