Previous circulations - Virtual Pathology



Previous circulations.

The main value of the EQA scheme is educational. Since July 2003, liver EQA slides have been available as digital images, and can be reviewed together with the responses of the scheme members and a summary of the meeting discussion.

It is often the case with liver biopsies that there is more than one diagnosis present, and/or that the diagnosis includes both morphological and aetiological components. The liver EQA response form is designed to accommodate this, although it is a challenge to condense the free text responses into diagnostic categories for discussion at the EQA meeting.

Previous circulations with diagnoses are presented here. You can see the preferred diagnosis by clicking the ‘see diagnosis’ button below the information provided on the case. It is best to also read the list of submitted responses of the EQA members, the decision for how to score the case, and discussion of the diagnosis. These are on the ‘EQA meeting with discussion’ powerpoint presentations, ................ The best way to use these is to have both open at the same time.

Circulation W

278 rejection – transplant biopsies taken elsewhere should be referred to the transplant centre for review.

279 no concensus, not scored. Hepatocellular carcinoma

280 fatty liver disease and haemochromatosis

281 metastatic fibrolammelar carcinoma in lymph node

282 primary biliary cirrhosis

283 hepatocellular carcinoma, cirrhosis, haemochromatosis

284 ciliated foregut cyst, background of cirrhosis

285 no concensus, not scored. Unilateral lobar atrophy, underlying cirrhosis, haemochromatosis.

286 cholestasis, likely drug reaction – drug history obtained after further questioning

287 metastatic colorectal carcinoma and embolisation material

288 no concensus, not scored. Biopsy within normal limits – high alk phos was bone origin

289 Hepatocellular carcinoma in slide 1; slide 2 diagnoses not scored.

Circulation X

290 steatohepatitis, probably due to alcohol

291 alpha 1 antitrypsin deficiency, cirrhosis or developing cirrhosis

292 focal nodular hyperplasia

293 liver cell adenoma

294 steatohepatitis, cirrhosis, probably due to NAFLD

295 cholangiocarcinoma

296 probable/definite cirrhosis, haemochromatosis

297 adenocarcinoma, probably metastatic

298 congenital hepatic fibrosis

299 focal nodular hyperplasia

300 hepatitis/chronic hepatitis, ? drug related

301 no concensus, not scored. Original diagnosis – end stage non-cirrhotic portal hypertension

Circulation Y

302 Granulomatous inflammation, BCG/TB

303 hepatitis C and transfusion haemosiderosis

304 no consensus, not scored, PBC ? with AIH overlap

305 Budd Chiari syndrome/venous outflow obstruction

306 hepatobiliary cystadenoma, mesenchymal stroma

307 acute hepatitis with bridging necrosis, probably autoimmune

308 Primary biliary cirrhosis

309 cholestasis, drug-induced (flucloxacillin)

310 hepatitis, autoimmune

311 cirrhosis, haemochromatosis, Hepatocellular carcinoma

312 hepatocellular carcinoma, cirrhosis

313 mild chronic hepatitis C

Circulation Z

314 biliary cystadenocarcinoma

315 metastatic adenocarcinoma (colorectal); nodular hyperplasia, sinusoidal obstruction syndrome related to oxaliplatin.

316 cholestasis, probably drug reaction (antibiotics)

317 cirrhosis, steatohepatitis, alcohol

318 primary biliary cirrhosis

319 hepatocellular carcinoma, cirrhosis

320 hepatocellular carcinoma

321 cholestatic hepatitis, c/w drug induced liver injury – mesalazine, autoimmune features

322 no consensus, not scored. Granulomatous inflammation, AIH and steatosis.

323 alcoholic steatohepatitis, central sclerosing hyaline necrosis

324 venous outflow obstruction, veno-occlusive disease

325 focal nodular hyperplasia

Circulation A1

326 autoimmune hepatitis (acute) with confluent necrosis

327 no consensus, not scored. Nodular regenerative hyperplasia

328 metastatic carcinoma – papillary carcinoma of thyroid

329 amyloid

330 no consensus, not scored. venous outflow obstruction/ Budd Chiari Syndrome

331 cirrhosis, haemochromatosis

332 focal nodular hyperplasia

333 hepatitis (acute, bridging necrosis) autoimmune

334 mild chronic hepatitis B and steatosis

335 iron overload, transfusional siderosis

336 hepatobiliary cystadenoma, mesenchymal stroma

337 cirrhosis, Hepatocellular carcinoma

Circulation B1

338 hepatitis, autoimmune

339 solitary biliary cyst

340 hepatitis C, bridging fibrosis/developing cirrhosis/Ishak stage 5

341 No consensus, not scored. Epithelioid haemangioendothelioma, sarcomatous

342 Early Hepatocellular carcinoma

343 Granulomatous inflammation, sarcoidosis

344 nodular regenerative hyperplasia/ non-cirrhotic portal hypertension

345 case not scored. Inflammatory (prev=telangiectatic) adenoma

346 hydatid cyst

347 severe acute hepatitis with panacinar necrosis (aetiology not scored)

348 hepatitis with granulomas, c/w TB

349 acute hepatitis with bridging necrosis, c/w autoimmune

Circulation C1

350 metastatic adrenal cortical carcinoma

351 cholestasis with ductopaenia (PSC)

352 chronic biliary disease, consistent with PBC

353 cirrhosis, hepatitis C

354 steatohepatitis, NASH

355 PBC, steatosis

356 cholestatic hepatitis, drug related

357 acute hepatitis with bridging necrosis, autoimmune

358 steatohepatitis, cirrhosis, NASH

359 autoimmune hepatitis

360 granulomatous inflammation, BCG

361 alcoholic steatohepatitis

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