Delayed immune-related sclerosing cholangitis after discontinuation of pembrolizumab: A case report

Figure 1 Imaging examinations of the gallbladder and common bile duct. A, B: Contrast-enhanced computed tomography shows swelling and wall thickness of the gallbladder and common bile duct; C, D: Endoscopic ultrasonography shows dilatation of the common bile duct without obstruction and wall thickness of the gallbladder; E: Endoscopic retrograde cholangiopancreatography shows a dilated common bile duct and irregularly narrowed right intrahepatic bile duct (white arrow); F: Intraductal ultrasonography shows the wall thickness from the right bile duct to the common bile duct (white arrowhead).

Figure 2 Pathological findings of the common bile duct and liver. A: Hematoxylin–eosin staining (× 40): Intraepithelial infiltrations of lymphocytes are observed; B and C: CD8 (B) and CD4 (C) staining (× 40): Infiltration of CD8⁺ T cells are predominant in the biliary epithelium compared to CD4⁺ T cells; D and E: Hematoxylin–eosin staining: On liver biopsy, inflammation of the hepatic parenchyma is not observed. The periductal "onion-skin" fibrosis is not observed in the portal area (black arrow); F and G: CD8 (F) and CD4 (G) staining (× 200): In a zoomed-in view of the portal area, predominant infiltration of CD8⁺ T cells, compared with CD4⁺ T cells, is observed.