A histologically proven case of progressive liver sarcoidosis with variceal rupture

Figure 1 Endoscopic examination at the time of cardial cariceal rupture. A: Endoscopic examination revealed active bleeding consequent to gastric cardial variceal rupture; B: Radiographic image of emergency endoscopic injection sclerotherapy with 5% ethanolamine oleate with iopamidol.

Figure 2 First histological examination of the liver, and the image of enhanced computed tomogram. A: The first liver biopsy showed non-caseating granulomas in the liver without fibrosis development. Aggregates of epithelioid histiocytes and Langhans-type giant cells were observed surrounded by lymphocytes. The original magnifications are × 40 and × 200, respectively; B: Enhanced computed tomogram showing multiple low-attenuation areas up to 10 mm in diameter, indicating multiple granulomas in the liver (white arrows). There was no splenomegaly at this time.

Figure 3 Second histological examination of the liver, and the image enhanced computed tomogram. A: The second biopsy revealed pseudo-lobular dense fibrosis with moderate infiltrating cells; B: The images of the enhanced computed tomography (CT) were significantly altered, too. The enhanced CT at the second biopsy showed a marked splenomegaly, and the surface of the liver was irregular, indicating portal hypertension and liver cirrhosis, respectively.