Liver injury associated with the use of selective androgen receptor modulators and post-cycle therapy: Two case reports and literature review

Figure 1 The liver biopsy specimen of case 1. Hematoxylin and eosin-stained histological evidence showing cholestatic injury, ductopenia, and chronic hepatitis with mild fibrosis after ligandrol and post-cycle therapy misuse. In the lobules, there is predominantly canalicular cholestasis, dilation and numerous biliary plugs between hepatocytes, in the Kupffer cells and fewer in the cytoplasm of centrilobular hepatocytes. There are focal degenerative signs of hepatocytes with vacuolization, without steatosis, with some spotty necrosis. In the portobiliary areas, there is a moderately dense inflammatory infiltrate with lymphocytes cluster of differentiation 3+ (CD3+), CD20 focally+, CD138 +/-, sketchy mild interface hepatitis, ductopenia, almost complete loss of biliary ducts, and peripheral ductular metaplasia of periportal hepatocytes (cytokeratin7+). Mild mononuclear inflammatory infiltrates in the sinusoids, markedly multiplied Kupffer cells with cholestasis. Mild portal fibrosis (Dr. Meciarova).