Liver biopsy in the post-hepatitis C virus era in Japan

Figure 1 A typical histologic finding of chronic hepatitis C. A dense, follicle-like accumulation of lymphocytes is seen in the portal area. Hematoxylin-eosin, original magnification 200 ×.

Figure 2 The number of liver biopsies conducted at Takatsuki General Hospital starting from 2011. In 2014, oral direct-acting antiviral agents were introduced, resulting in a steady decline of liver biopsies.

Figure 3 Biopsy from 2 patients. A and B: A liver biopsy from a 78-year-old male positive for antinuclear antibody. Hematoxylin-eosin (HE), original magnifications 40 × (A); HE, original magnifications 400 × (B); C-E: A liver biopsy from a 62-year-old male patient with diabetes mellitus. HE, original magnifications 100 × (C), 200 ×(D) and 200 ×(E).

Figure 4 A schematic illustration indicating the relationships among metabolic-dysfunction associated steatotic liver disease, autoimmune liver diseases and autoantibody-positivity. MASLD: Metabolic-dysfunction associated steatotic liver disease; MASH: Metabolic-dysfunction associated steatohepatitis.

Figure 5 Findings of comparative biopsies before and after hepatitis C virus eradication with direct-acting antiviral agents. While inflammation, fibrosis and iron deposition have improved, steatosis has not changed and appears to have worsened[8].

Figure 6 A typical case of hepatitis C virus-associated hepatocellular carcinoma. A: Hematoxylin-eosin (HE), original magnifications 20 ×; B: HE, original magnifications 100 ×.

Figure 7 Trends in the number of tumor biopsies at Kansai Medical University Medical Center. Meta: Metastatic tumor; HCC: Hepatocellular carcinoma.

Figure 8 Liver biopsy from 3 patients. A-C: A biopsy of hepatic tumor from a 60-year-old female patient previously diagnosed as hepatocellular carcinoma. Hematoxylin-eosin (HE), original magnifications 20 × (A), 100 × (B); Immunostaining for synaptoophysin, original magnification 100 × (C); D and E: A liver biopsy from a 72-year-old female patient diagnosed as drug-induced liver injury. HE, original magnification 100 × (D); Azan-Mallory stain, original magnification 100 × (E); F-I: A liver biopsy from a 76-year-old male patient with bile duct injury due to inhibitors-related adverse effects. HE, original magnification 100 × (F); Elastica van Gieson, original magnification 100 × (G); Immunostaining for CD3 and cytokeratin 7, original magnification 100 × (H, I). CK7: Cytokeratin 7.