case_images: PMC9968480_01
case_images: Endoscopic findings of Case 1. The findings show gastric varices with erosions (white arrows) on the surface, but no red color sign is present
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case_images: PMC9968480_01_cureus-0015-00000034275-i01.jpg
case_images: FIG1
case_images: Upper gastrointestinal endoscopy showed gastric varices (Figure 1).
case_images: Histological findings of Case 1. (a) Hematoxylin-eosin-stained liver biopsy tissues reveal an increased number of bile ducts (blue arrows) and the presence of chronic non-suppurative destructive cholangitis. (b) Hematoxylin-eosin-stained liver biopsy tissues show the presence of emperipolesis (red arrows) and plasma cell infiltration. (c) Masson-trichrome-stained liver biopsy tissues reveal liver cirrhosis
case_images: cureus-0015-00000034275-i02.jpg
case_images: PMC9968480_01_cureus-0015-00000034275-i02.jpg
case_images: FIG2
case_images: Histological findings revealed an increased number of bile ducts and the presence of chronic non-suppurative destructive cholangitis (CNSDC) (Figure 2a). Moderate-to-severe lymphocytic and plasma cell infiltration in the portal region, interface hepatitis, hepatocellular rosettes, and emperipolesis were also noted (Figure 2b). Fibrous enlargement of the portal region and fibrous crosslink formation were observed (Figure 2c).
case_images: CT images of Case 1. (a) CT image on admission: coarse liver parenchyma, mild splenomegaly, gastro-renal shunt, and mild splenomegaly are seen. (b) CT image after four months: mild hepatic atrophy and slight ascites are present. (c) CT image after eight months: liver atrophy is rapidly progressing (red arrows) and severe ascites is seen (white *). CT: computed tomography
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case_images: PMC9968480_01_cureus-0015-00000034275-i03.jpg
case_images: FIG3
case_images: CT images over time showed rapid liver atrophy and increased ascites (Figure 3).
case_images: Clinical course of Case 1. The solid line indicates the total bilirubin value, and the dotted line corresponds to the Model for End-Stage Liver Disease score. The thin arrow indicates the date of the liver biopsy and the thick arrow indicates the date of registration for liver transplantation
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case_images: FIG4
case_images: The patient subsequently died of advanced liver failure with gastrointestinal bleeding (Figure 4).
case_images: PMC9968480_02
case_images: Histological findings of Case 2. (a) Hematoxylin-eosin-stained liver biopsy tissues reveal infiltration of lymphocytes and chronic non-suppurative destructive cholangitis (blue arrows) in the portal region. (b) Hematoxylin-eosin-stained liver biopsy tissues show the presence of many Mallory bodies in the hepatic lobules, indicating the influence of alcoholic hepatitis. (c) Masson-trichrome-stained liver biopsy tissues reveal liver cirrhosis
case_images: cureus-0015-00000034275-i05.jpg
case_images: PMC9968480_02_cureus-0015-00000034275-i05.jpg
case_images: FIG5
case_images: Histological findings revealed infiltration of lymphocytes and CNSDC in the portal region (Figure 5a). There were also many Mallory bodies in the hepatic lobules, indicating the influence of alcoholic hepatitis with liver cirrhosis (Figures 5b, 5c).
case_images: CT and MRI findings of Case 2. (a) Contrast-enhanced CT image at admission: a liver cirrhosis pattern is seen. (b) MRI image with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid after nine months: there is no progression of hepatic atrophy, but a high/low-pattern hepatocellular carcinoma is seen in liver segment 6 (red circle). Liver hardness is equivalent to F4. CT: computed tomography; MRI: magnetic resonance imaging
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case_images: FIG6
case_images: Enhanced MRI was performed at nine months during outpatient follow-up and revealed hepatocellular carcinoma (HCC) in liver segment 6 (Figure 6).