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. 2017 Oct 10;2(4):e000268. doi: 10.1136/esmoopen-2017-000268

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© European Society for Medical Oncology (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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(A) Graph showing the changes in liver function tests over time for case 2, with a summary of systemic treatments given over time. The right y-axis refers to bilirubin levels, the left y-axis refers to ALP and ALT levels. (B) Photomicrograph of a representative H&E section from a liver biopsy in case 2. This section shows degenerative duct atypia and periductal fibrosis, similar to that observed in chronic biliary disease. (C) Photomicrograph of the same portal tract in B, with elastic picro sirius red staining, demonstrating fibrosis (collagen in red). (D) Photomicrograph showing cytokeratin 7 immunohistochemistry of a representative section from a liver biopsy in case 2. This shows patchy periportal intermediate hepatobiliary phenotype, suggesting a cholangiopathic process. ALP, alkaline phosphatase; ALT, alanine aminotransferase; CS, corticosteroids; U, ursodeoxycholic acid; ULN, upper limit of normal.