PMC3656669_01
Liver biopsy before and after rituximab treatment. H&E staining. a, b Before rituximab. Moderate lymphocyte and plasmacyte infiltration as well as chronic non-suppurative destructive cholangitis were found. Mild pericellular fibrosis was seen, but bridging fibrosis was absent. a beta40; b beta400. c, d After rituximab treatment, intralobular bile duct loss with minimal portal inflammation was seen. c beta40; d beta400.
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F1
Prior to treatment for DLBCL, we performed a biopsy on the right lobe of the liver and found chronic non-suppurative destructive cholangitis with interface hepatitis consistent with PBC at Scheuer's histological stage II (fig. 1a, b). Moreover, we found that portal inflammation had decreased after rituximab treatment (fig. 1c, d).
Clinical course of this case. The arrowhead indicates the timing of liver biopsy (Bp). Gray bars indicate administration of rituximab (Rit), black bars indicate a cycle of CHOP. White bars indicate radiation (Rad). The Mayo risk score is shown (Risk score). The titers of AMA-M2 and IgM are shown. In the lower graph, the black square line indicates serum ALP level, whereas the circle dotted line indicates serum bilirubin level.
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F2
Thereafter, she was treated with chemotherapy, including rituximab (R-CHOP - cyclophosphamide/hydroxydaunorubicin/oncovin/prednisone, rituximab 375 mg/m2) plus radiation 40 Gy as shown in figure 2. After treatment with 8 doses of rituximab, her biliary enzyme and serum IgM levels decreased gradually and the AMA titer also decreased (fig. 2). She was asymptomatic and her PBC Mayo risk scores remained low for 24 months after diagnosis of DLBCL (fig. 2).
Autopsy findings. a, c H&E staining; b Azan staining. a, b Bridging fibrosis was found (beta4). c Portal inflammation was unclear (beta400).
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F3
Autopsy showed bridged fibrosis formation of the liver (fig. 3a, b, Scheuer's histological stage IV) and lower bile duct cancer. Prominent infiltration of inflammatory cells was not found in the liver (fig. 3c).