Case of autoimmune hepatitis with markedly enlarged hepatoduodenal ligament lymph nodes

Figure 1 Imaging findings. A: Dynamic computed tomographic image (CT) of a transverse section; B: A coronal section revealing enlargement of the hepatoduodenal ligament lymph nodes (arrows); C: Ultrasonography of the abdomen revealing a large mass in the region of the hepatic portal vein (arrow); D: Positron emission tomography/CT using ¹⁸F-fluorodeoxyglucose revealing mild accumulation. The maximum standardized uptake value was 3.98. The arrow shows the hepatoduodenal ligament lymph nodes.

Figure 2 Liver biopsy. A: Liver biopsy specimen with hematoxylin and eosin staining (× 100 magnification) revealing the histopathological appearance of acute hepatitis. Interface hepatitis and plasmacytic infiltrates are present; B: This is the same image at × 400 magnification. P: Portal area; C: Central vein area.

Figure 3 Histological sections of hepatoduodenal ligament lymph nodes (× 200 magnification). A: The lymphoid follicles contain a reactive germinal center with hematoxylin and eosin staining. No evidences of granuloma or necrosis are visible; B: CD3 (T-cell marker) is positive in the interfollicular areas; C: CD10 (a marker of B-cell activation) is positive in the center of the follicles; D: CD20 (B-cell marker) is observed in the nodules; E: Kappa chain; F: Lambda chain. Neither the kappa nor the lambda chains predominate.

Figure 4 Clinical course. The patients showed high levels of alanine aminotransferase, alkaline phosphatase and total bilirubin. However, after the initial corticosteroid therapy, these levels improved gradually. ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; T-Bil: Total bilirubin.

Figure 5 Computed tomography of the transverse section recorded 2 mo after starting corticosteroid. The hepatoduodenal ligament lymph nodes reduced in size.