In addition, the portal tracts contain a granulomatous inflammatory component which is composed of loose accumulations of epithelioid cells in one portal tract and inclusion-bearing giant cells in two others. Bile duct loss is not evident, and classic florid duct lesion are not seen. Several portal tracts show a prominent lymphocytic cholangitis with bile duct injury and infiltrating lymphocytes, whereas other portal tracts demonstrate portal edema and ductular proliferation together with swelling and luceny of periportal liver cells suggestive of chronic cholestasis. The lobules show minor reactive changes. Because of the granulomatous component, microbial stains should be obtained although the yield is apt to be low.
Sarcoidosis is another unlikely consideration.
Because of the granulomas and the prominent inflammatory component of the portal process, primary biliary cirrhosis or autoimmune cholangitis would be leading choices, although the absence of more demonstrable bile duct loss argues somewhat against this. Please send any follow up information you receive. All rights reserved. Unauthorized redistribution prohibited.