PMC6875346_01
Liver biopsy from Case 1 demonstrates a portal tract with a vague poorly-formed non-necrotic granuloma (arrows) and adjacent lymphocytic inflammation. H&E stain, 20x.
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Histologic examination of the liver biopsy showed mild portal inflammation with rare vague poorly-formed non-necrotic granulomas which were not centered on bile ducts (Figure 1).
Trichrome stain performed on Case 1 shows the portal tract with the granuloma (arrows) demonstrating mild fibrous expansion (blue). Masson trichrome, 20x.
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fig2
Trichrome stain showed mild periportal fibrosis (Figure 2).
Electron microscopy performed on Case 1 reveals foreign particles within a macrophage.
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Electron microscopy performed for further evaluation of the granulomas revealed foreign particles within the macrophages (Figure 3).
Energy-dispersive spectroscopy (EDS) performed on Case 1 confirms the presence of a small amount of silica and aluminum (arrow) within the macrophages.
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Analysis by energy dispersive spectroscopy (EDS) showed small amounts of silica and aluminum in these particles (Figure 4).
PMC6875346_02
(a) Liver biopsy from Case 2 shows a classic silicone granuloma with multinucleated giant cells (arrows) containing clear vacuoles of varying sizes portraying a "swiss cheese-like" appearance. H&E stain, 20x. (b) A portal tract from Case 2 is filled with silicone granulomas and demonstrates periportal ductular reaction (arrows) with associated neutrophilic inflammation indicative of bile duct obstruction. H&E stain, 10x.
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fig5
Histologic examination of the liver biopsy demonstrated numerous non-necrotic foreign body giant cell type granulomas containing clear vacuoles of varying sizes present in the portal tracts and lobules (Figure 5(a)). Histologic features of large bile duct obstruction were also present (Figure 5(b)).
Trichrome stain performed on Case 2 highlights periportal fibrosis (left) and peri-granuloma fibrosis (right) bright blue. Masson trichrome, 10x.
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fig6
Trichrome stain showed periportal fibrosis with few fibrous septa and fibrosis around lobular granulomas (Figure 6).