This EASL Quiz was developed in collaboration with ERN.

A 41-year-old woman with a history of Sjögren syndrome is referred to the hepatology department for persistent thrombocytopenia (platelet count 98 × 10⁹/L). Abdominal ultrasound shows homogeneous liver parenchyma and splenomegaly (15 cm), with a patent 13 mm wide portal vein. Liver stiffness measurement is 6 kPa and spleen stiffness measurement is 30 kPa. Upper gastrointestinal endoscopy reveals small oesophageal varices.

A transjugular liver biopsy (non-fragmented 2 cm length) adequately excludes cirrhosis. Histological examination shows portal venule stenosis involving 35% of portal tracts and regenerative changes in the absence of nodular regenerative hyperplasia. No additional relevant histological abnormalities are identified.