case_images: PMC6875346_01
case_images: 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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case_images: fig1
case_images: 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).
case_images: Trichrome stain performed on Case 1 shows the portal tract with the granuloma (arrows) demonstrating mild fibrous expansion (blue). Masson trichrome, 20x.
case_images: CRIHEP2019-7348168.002.jpg
case_images: PMC6875346_01_CRIHEP2019-7348168.002.jpg
case_images: fig2
case_images: Trichrome stain showed mild periportal fibrosis (Figure 2).
case_images: Electron microscopy performed on Case 1 reveals foreign particles within a macrophage.
case_images: CRIHEP2019-7348168.003.jpg
case_images: PMC6875346_01_CRIHEP2019-7348168.003.jpg
case_images: fig3
case_images: Electron microscopy performed for further evaluation of the granulomas revealed foreign particles within the macrophages (Figure 3).
case_images: Energy-dispersive spectroscopy (EDS) performed on Case 1 confirms the presence of a small amount of silica and aluminum (arrow) within the macrophages.
case_images: CRIHEP2019-7348168.004.jpg
case_images: PMC6875346_01_CRIHEP2019-7348168.004.jpg
case_images: fig4
case_images: Analysis by energy dispersive spectroscopy (EDS) showed small amounts of silica and aluminum in these particles (Figure 4).
case_images: PMC6875346_02
case_images: (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.
case_images: CRIHEP2019-7348168.005.jpg
case_images: PMC6875346_02_CRIHEP2019-7348168.005.jpg
case_images: fig5
case_images: 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)).
case_images: Trichrome stain performed on Case 2 highlights periportal fibrosis (left) and peri-granuloma fibrosis (right) bright blue. Masson trichrome, 10x.
case_images: CRIHEP2019-7348168.006.jpg
case_images: PMC6875346_02_CRIHEP2019-7348168.006.jpg
case_images: fig6
case_images: Trichrome stain showed periportal fibrosis with few fibrous septa and fibrosis around lobular granulomas (Figure 6).