Patients With Autoimmune Hepatitis Who Have Antimitochondrial Antibodies Need Long-term Follow-up to Detect Late Development of Primary Biliary Cirrhosis  Amreen M. Dinani, Sandra E. Fischer, Jeff Mosko, Maha Guindi, Gideon M. Hirschfield  Clinical Gastroenterology and Hepatology  Volume 10, Issue 6, Pages 682-684 (June 2012) DOI: 10.1016/j.cgh.2012.02.010 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Histologic findings illustrating biliary changes consistent with the development of PBC in 3 patients with AMA-positive autoimmune hepatitis. (A) Liver biopsy 10 years after initial diagnosis of AIH in case 1. Marked lymphocytic infiltrate in portal tracts (arrow) with no identifiable native interlobular bile ducts (H&E, ×100). (B) Immunohistochemistry staining for keratin 7 shows ductular reaction and no native bile ducts in the portal area (×100). (C) Initial liver biopsy of second AMA-positive patient showing hepatitis featured by portal and lobular necroinflammatory changes in the absence of biliary changes such as lymphocytic cholangitis and duct loss (H&E, ×100). (D) Repeat liver biopsy 5 years later for increasing ALP level showing duct loss (arrows) and mild parenchymal hepatitis (Masson trichrome stain, ×400). (E) Initial liver biopsy of third AMA-positive patient with marked lobular necroinflammatory changes (H&E, ×100). (F) Hepatitis with portal inflammation and focal duct loss identified in the same patient 4 years later (Masson trichrome stain, ×200). Clinical Gastroenterology and Hepatology 2012 10, 682-684DOI: (10.1016/j.cgh.2012.02.010) Copyright © 2012 AGA Institute Terms and Conditions