IgG4-Related Sclerosing Cholangitis Involving the Intrahepatic Bile Ducts Diagnosed with Liver Biopsy

Figure 2

Liver core needle biopsy findings in a patient with IgG4-related sclerosing cholangitis (IgG4-SC). (a) A portal inflammatory nodule (IN), showing storiform fibrosis (arrows) and diffuse lymphoplasmacytic infiltration (H&E). (b) Higher magnification of the storiform fibrosis (H&E). (c) Strong infiltration of lymphocytes and plasma cells in the wall of the bile duct (Methyl-Green Pyronin). (d) Deeper section of the same area shown in Figure 2(a). At the periphery of the IN, there is obliterative phlebitis (arrows). Note the wall of the corresponding artery (Verhoeff elastin). (e) Higher magnification of the area with obliterative phlebitis shown in Figure 2(d). The former lumen of the vein is filled with plasma cells and lymphocytes. The vein can only be identified using an elastin stain (Verhoeff elastin). (f) Deeper sections of the area shown in Figure 2(a). Strong infiltration of IgG4-positive cells in the IN. (g, h) The IgG4 / IgG ratio is 72%.

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