case_images: PMC7382729_01
case_images: Liver biopsy (a, b) infiltration of normal hepatic parenchyma by irregular glands with surrounding eosinophilic material (H&E; (a) 40x, (b) 100x); (c) eosinophilic material with a globular morphology (H&E, 200x); (d) eosinophilic material appearing salmon-orange on Congo red stain (Congo red, 100x); (e) eosinophilic material with apple-green birefringence under polarized light (Congo red, polarized, 100x).
case_images: CRIPA2020-8830763.001.jpg
case_images: PMC7382729_01_CRIPA2020-8830763.001.jpg
case_images: fig1
case_images: At low magnification, the biopsy revealed almost complete destruction of the hepatic parenchyma by irregular glands surrounded by fibrous tissue (Figure 1(a)). Medium power showed dense pale eosinophilic material separating angulated glands lined by cells with a moderate amount of deeply eosinophilic cytoplasm with round to ovoid hyperchromatic nuclei (Figure 1(b)). The pale eosinophilic material was also present within the sinusoids of uninvolved hepatocytes (Figure 1(c)). A Congo red stain was performed, which showed salmon-orange areas around the glands and within the sinusoids and vasculature, some of which showed a globular appearance (Figure 1(d)). These areas displayed apple-green birefringence under polarized light and surrounded the glands and involved vessel walls (Figure 1(e)).