PMC10203514_01
(A) Ascending colon; (B) transverse colon; (C) Rectum, (D) Pathology. Colonoscopy images show the ascending colon mucosa scattered in sheet congestion edema with a granular surface. The transverse colon mucosa are scattered in sheet erythema. The descending colon and sigmoid mucosa are smooth. Erosive, ulceration, loss of vascular markings, or mucosal friability are not observed in the patient. (E) An enhanced CT scan of the liver shows that the liver surface is not smooth and the intrahepatic bile ducts are slightly dilated. (F) MRCP shows segmental dilatation of the intrahepatic bile ducts. (G) Moderate interface inflammation and significant lymphoplasmacytic infiltration; (H) Immunohistochemistry MUM1 (+); (I) Some bile ducts are surrounded by lymphocytes and phagocytes, and lymphocytes involved in the bile duct; (J) Immunohistochemistry CK7 (+); (K) Concentric fibrotic changes around the large bile duct with scattered plasma cell infiltration, and bile duct hyperplasia was seen in the converduct area; (L) MASSON staining showed concentric fibrosis changes and deformation of the bile duct.
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An enhanced CT scan of the liver and the MRCP findings are shown in  Figure 1 . The pathological morphology was suggestive of PSC-AIH overlap syndrome (G3-4,S3) ( Figure 1 ). A colonoscopy revealed changes in colonic inflammation (predominantly in the right colon) ( Figure 1 ). Pathology in the colon showed chronic inflammation (plasmacytosis and lymphocyte) of the mucosa, erosion, gland atrophy, crypt distortion, and cryptitis ( Figure 1 ).