Eosinophilic Cholangitis and Cholangiopathy: A Sheep in Wolves Clothing
Figure 2
(a) Low power magnification displaying a common bile duct wall with bile duct mucosal glands, composed of columnar cells with basally oriented nuclei and subepithelial collagen. There is no epithelial atypia. The subepithelial area shows periductal fibrosis and pronounced diffuse inflammatory cellular infiltrate. White circle indicates infiltrate. (Hematoxylin and Eosin stain; (b) displaying 20x; (c) displaying 40x magnification). (b) and (c) Higher-power view demonstrating bile duct mucosal glands composed of columnar cells with basally oriented nuclei. In the subepithelial region, there is a dense infiltrate comprising predominantly of eosinophils, identified by their pathognomonic cytoplasmic granules and bilobed nuclei. The eosinophils are present diffusely within the stroma and around the glands. However, in some areas, these cells form clusters of four to five cells. The white arrows demonstrate the clusters of eosinophils. Along with the eosinophils, other inflammatory cells are also identified, including lymphocytes with scanty cytoplasm and small hyperchromatic dark blue nuclei as well as the larger neutrophils with their granular cytoplasm and multilobed nuclei. (Hematoxylin and Eosin stain; 1b displaying 20x; 1c displaying 40x magnification).
