Liver EQA Scheme Circulation D1 Summer ... - Virtual Pathology



Liver EQA Scheme Circulation LT - Spring 2019

MCQs - for delegates who are not members of the Liver EQA Scheme.

The Liver Pathology meeting on 7th November includes discussions of this year's two rounds of the liver EQA Scheme, LT and LU.

Since there are many delegates at the meeting who are not EQA Scheme members, we produce a set of MCQs for cases to make the most of their educational value for everyone in the audience.

Please find time to look at the cases before the meeting - you can do this either from the summary photographs from the powerpoint presentation for the meeting, or the full digital slides. Instructions are on our website

You can mark your MCQ answers on this sheet - hopefully there will be an opportunity for live interactive voting during the meeting. This year will be our first time for live voting, fingers crossed it works well,

Judy Wyatt, Liver EQA Scheme Organiser. 23.10.19

|Case number: |LT1 |

|Clinical Information: |NAFLD. Normal immunoglobulins and weakly positive SMA. Recent rise in LFT's. Alcohol 15 units per |

| |week. |

|Specimen: |Liver biopsy |

|Age: |65 |

|Sex: |Female |

|Macroscopic description: |two cores 20mm and 17 mm |

|Immunohistochemistry: |Retic, Sirius red. |

|LT1 | |

|A |Steatosis either alcohol or non alcohol related |

|B |Steatosis alcohol related |

|C |Autoimmune hepatitis with background steatosis |

|D |Steatohepatitis either alcohol or non alcohol related |

|E |Steatohepatitis alcohol related |

|Case number: |LT2 |

|Clinical Information: |Highish ferritin and cirrhosis, no cause found, genotype neg for haemochromatosis but if has xs iron I would |

| |venesect. Rest of liver screen neg apart from sl high IgG, ANA neg. Is there significant iron overload and any |

| |other cause of cirrhosis. Very little alcohol. |

|Specimen: |Liver, core biopsy |

|Age: |74 |

|Sex: |Male |

|Macroscopic description: |A cylinder of tan tissue measuring 24mm plus fragments of similar tissue. |

|Immunohistochemistry: |Sirius Red Fast Green, Perls, DPAS, A1AT |

|LT2 | |

|A |Autoimmune hepatitis |

|B |Burnt out fatty liver disease |

|C |Fe deposition |

|D |Alpha 1 antitrypsin accumulation and Fe deposition |

|E |Alpha 1 antitrypsin accumulation |

|Case number: |LT3 |

|Clinical Information: |Laparoscopic cholecystectomy for gallstones-liver lesion segment 4. |

|Specimen: |liver resection |

|Age: |53 |

|Sex: |Male |

|Macroscopic description: |Wedge of liver 12 x 9 x 2 mm |

|Immunohistochemistry: |none |

| | |

|LT3 | |

|A |Bile duct adenoma/peribiliary gland hamartoma |

|B |Microhamartoma |

|C |Von Meyenberg complex |

|D |Bile duct hamartoma |

|E |Adenocarcinoma deposit |

|Case number: |LT4 |

|Clinical Information: |HCV and history of heavy alcohol. Fibroscan reassuring but low platelets. ? significant fibrosis. |

|Specimen: |liver biopsy |

|Age: |67 |

|Sex: |Male |

|Macroscopic description: |2 cores 12 and 24mm long |

|Immunohistochemistry: |EPSR |

|LT4 | |

|A |AIH and fatty liver disease (alcohol related) |

|B |HCV and fatty liver disease (alcohol related) |

|C |HCV |

|D |Fatty liver disease (alcohol related) |

|E |AIH |

|Case number: |LS5 |

|Case number: |LT5 |

|Clinical Information: |CWT patient. Segment VIII liver lesion biopsy. + background liver biopsy (segment IV). MWA post |

| |biopsy. ?HCC. |

|Specimen: |Liver biopsy, segment VIII, USG 18G |

|Age: |66 |

|Sex: |Male |

|Macroscopic description: |A core of cream and tan tissue measuring 15mm in length and 1mm in diameter together with |

| |fragments measuring 3mm in aggregate. |

|LT5 | |

|A |Focal nodular hyperplasia |

|B |Hepatocellular adenoma |

|C |Hepatocellular carcinoma |

|D |Bile duct adenoma |

|E |Fibrolamellar hepatocellular carcinoma |

|Case number: |LT6 |

|Clinical Information: |Cirrhosis |

|Specimen: |Liver explant |

|Age: |70 |

|Sex: |Male |

|Macroscopic description: |A total hepatectomy, weighing 2030 grams. On slicing, within segment VI and VII, there is a |

| |variegated cream/haemorrhagic/bile stained tumour with thickened capsule, which measures 40 x 29 |

| |x 22mm. The background liver shows some ill-defined nodularity. |

|Immunohistochemistry: |none submitted for EQA |

|LT6 | |

|A |Hepatocellular carcinoma with treatment effects |

|B |Hepatocellular carcinoma |

|C |Focal nodular hyperplasia |

|D |Adenoma |

|E |Fibrolamellar carcinoma |

|Case number: |LT7 |

|Clinical Information: |61 year old male. Jaundice and progressively cholestatic LFT. Dilated cardiomyopathy and liver congestion. |

| |Has ICD/CRT-D. Bili 80, ALT 12, ALP 203, GGT 312. ?Drug induced cholestasis. ?Cardiac cirrhosis. DH |

| |Rivaroxaban. |

|Specimen: |Liver biopsy, USG plugged |

|Age: |61 |

|Sex: |Male |

|Macroscopic description: |Three tan cores measuring 5, 7 and 17mm |

|Immunohistochemistry: |none submitted to EQA |

|LT7 | |

|A |Biliary disease |

|B |Drug induced liver injury DILI |

|C |Vascular disease (outflow obstruction) and DILI |

|D |Vascular disease (outflow obstruction) |

|E |Peliosis hepatis |

|Case number: |LT8 |

|Clinical Information: |Sepsis of unknown origin. Fever, night sweats, rigor and lethargy. Intravesicle injection BCG for|

| |bladder cancer 2 months previously. Deranged liver function tests. |

|Specimen: |Liver Biopsy |

|Age: |55 |

|Sex: |Male |

|Macroscopic description: |15mm strand of tissue. |

|Immunohistochemistry: |NONE |

|LT8 | |

|A |Granulomatous hepatitis ? Drug induced liver injury |

|B |Granulomas most likely sarcoidosis |

|C |Granulomas most likely TB |

|D |Granulomas, most likely primary biliary cholangitis |

|E |Granulomatous inflammation most likely due to BCG |

|Case number: |LT9 |

|Clinical Information: |Obstructive jaundice secondary to biliary adenoma [sic] |

|Specimen: |Native liver, hepatectomy |

|Age: |62 |

|Sex: |Female |

|Macroscopic description: |Intraductal lesion within CBD, CHD and into R/LHD. |

|Immunohistochemistry: |Nil |

|LT9 | |

|A |Intraductal Papillary Neoplasia of the Bile Duct (IPNB) or Intraductal TubuloPapillary |

| |NeoplasmPNB (ITPN) |

|B |Intraductal cholangiocarcinoma |

|C |Hepatobiliary cystadenocarcinoma |

|D |Biliary Intra-epithelial Neoplasia (BilIN) |

|E |Biliary papillomatosis |

|Case number: |LT10 |

|Clinical Information: |High suggestion of fibrosis. Benign biliary stricture ? secondary to chronic pancreatitis |

|Specimen: |Liver biopsy |

|Age: |69 |

|Sex: |Female |

|Macroscopic description: |Tan core 25mm |

|Immunohistochemistry: |HVG |

|LT10 | |

|A |Chronic hepatitis differential diagnosis AIH DILI viral |

|B |Biliary features secondary to large bile duct obstruction |

|C |Biliary features likely biliary tract disease (PBC PSC) |

|D |Biliary features likely IgG4 disease |

|E |Metastatic adenocarcinoma |

|Case number: |LT11 |

|Clinical Information: |Cardiac cirrhosis? under investigations. Mild constrictuive pericarditis/bicuspid aortic valve |

| |with tissue valve replacement. Any evidence of cirrhosis? drug induced liver injury? alcohol |

| |related? |

|Specimen: |transjugular liver biopsy |

|Age: |66 |

|Sex: |Male |

|Macroscopic description: |liver biopsy - three cores 15mm max |

|Immunohistochemistry: |EVG, CK7 |

|LT11 | |

|A |Drug induced liver injury |

|B |Alcohol related liver disease |

|C |Cholestasis/Biliary disease |

|D |Venous outflow obstruction |

|E |Sickle cell disease |

|Case number: |LT12 |

|Clinical Information: |Hepatic adenoma 100K Genome project sent fresh. Not sampled for Genome project. |

|Specimen: |Left lateral sectionectomy (segments 2 and 3). |

|Age: |50 |

|Sex: |Female |

|Macroscopic description: |Specimen weight: 411g. Specimen dimensions: Supero-inferior180mm, Medio-lateral 105mm, |

| |Antero-posterior 45mm Tumour appearance: Multinodular, irregularly shaped, tan with interspersed |

| |vessels, and focal central ?fibrosis., Tumour size: 115mm x 95mm x 45mm |

|Immunohistochemistry: |Keratin 7, Glutamine synthetase, van Gieson, Shikata |

|LT12 | |

|A |Hepatocellular adenoma |

|B |Cirrhosis |

|C |Focal nodular hyperplasia |

|D |Hepatocellular carcinoma |

|E |Nodular regenerative hyperplasia |

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