Liver EQA Scheme Circulation D1 Summer 2011
Liver EQA Scheme Circulation LU - Summer 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: | |
|LU1 (ID 1653) | |
| | |
|Clinical Information: | |
|Deranged LFTs, increased serum ACE level. | |
| | |
|Specimen: | |
|Liver biopsy | |
| | |
|Age: | |
|45 | |
| | |
|Sex: | |
|Male | |
| | |
|Macroscopic description: | |
|Two cores 18mm and 16mm | |
| | |
|Immunohistochemistry: | |
|None | |
| | |
|LU1 | |
|A |Granulomas most likely TB |
|B |Granulomas most likely sarcoid |
|C |Biliary disease |
|D |Primary biliary cholangitis |
|E |Granulomatous hepatitis, ? Drug induced liver injury |
|Case number: |LU2 (ID 1516) |
|Clinical Information: |Patient presented with jaundice and diagnosed with AIH. Trial of steroids 0 no improvement. This is|
| |a follow up biopsy. |
|Specimen: |transjugular liver biopsy |
|Age: |66 |
|Sex: |Female |
|Macroscopic description: |4 cores, 19,8,7 and 3mm |
|Immunohistochemistry: |EPSR |
|LU2 | |
|A |Hepatitis chronic with fibrosis ikw AIH |
|B |Hepatitis acute with necrosis ikw AIH |
|C |Hepatitis most likely drug |
|D |Hepatitis most likely viral e.g. Hep E |
|E |Wilson disease |
|Case number: | |
|LU3 (ID 1444) | |
| | |
|Clinical Information: | |
|liver transplant for autoimmune hepatitis | |
| | |
|Specimen: | |
|liver explant | |
| | |
|Age: | |
|59 | |
| | |
|Sex: | |
|Male | |
| | |
|Macroscopic description: | |
|explant liver 1316g, cirrhotic appearance, no focal lesions seen. | |
| | |
|Immunohistochemistry: | |
|retic, vg, shikata | |
| | |
|LU3 | |
|A |Wilson disease |
|B |Dysplastic nodules |
|C |Hepatocellular carcinoma |
|D |Congenital hepatic fibrosis |
|E |Post necrotic collapse/fibrosis ikw AIH |
|Case number: | |
|LU4 (ID 1697) | |
| | |
|Clinical Information: | |
|New acute hepatitis ? cause. Persistently elevated ALT 330 and bilirubin 150 with pruritis/jaundice/headache for several weeks. ? viral ? | |
|autoimmune. USS no duct dilatation. | |
| | |
|Specimen: | |
|liver biopsy | |
| | |
|Age: | |
|22 | |
| | |
|Sex: | |
|Male | |
| | |
|Macroscopic description: | |
|One core 27mm long | |
| | |
|Immunohistochemistry: | |
|Shikata, CK7, retic, EVG | |
| | |
|LU4 | |
|A |Chronic biliary features, ? large bile duct obstruction,PSC |
|B |Acute hepatitis ikw drug |
|C |Acute hepatitis ikw AIH |
|D |Chronic hepatitis |
|E |Wilson disease |
| | |
|Case number: | |
|LU5 (ID 1674) | |
| | |
|Clinical Information: | |
|NAFLD. Fibroscan 12. Moderate fibrosis? on Humira for rheumatoid arthritis. | |
| | |
|Specimen: | |
|Liver biopsy | |
| | |
|Age: | |
|55 | |
| | |
|Sex: | |
|Male | |
| | |
|Macroscopic description: | |
|tan core 31mm | |
| | |
|Immunohistochemistry: | |
|HVG | |
| | |
|LU5 | |
|A |DILI with background steatosis |
|B |steatohepatitis |
|C |steatosis |
|D |Rheumatoid related liver disease |
|E |Biliary disease with background steatosis |
|Case number: | |
|LU6 (ID 1626) | |
| | |
|Clinical Information: | |
|Liver cirrhosis, mass lesion in segment VIII/IVa, ?HCC | |
| | |
|Specimen: | |
|Sement VIII/IVa segmentectomy | |
| | |
|Age: | |
|80 | |
| | |
|Sex: | |
|Female | |
| | |
|Macroscopic description: | |
|Segment of liver 70 x 68 x 35 mm containing a mass lesion 22 x 22 x 18mm | |
| | |
|Immunohistochemistry: | |
|none | |
| | |
|LU6 | |
|A |Regenerative nodule background cirrhosis |
|B |HCC background cirrhosis |
|C |FNH background cirrhosis |
|D |Adenoma background cirrhosis |
|E |Focal Steatotic nodule |
| |Case number: |
| |LU7 (ID 1824) |
| | |
| |Clinical Information: |
| |Portal hypertension. being assessed for TIPPS; ? cirrhosis |
| | |
| |Specimen: |
| |liver biopsy |
| | |
| |Age: |
| |24 |
| | |
| |Sex: |
| |Male |
| | |
| |Macroscopic description: |
| |tan core 12mm |
| | |
| |Immunohistochemistry: |
| |add stains ? which - being scanned |
| | |
|LU7 | |
|A |Venous outflow obstruction |
|B |Biliary disease +/- possible sclerosing cholangitis |
|C |Normal liver |
|D |Vascular disease ‘Non cirrhotic portal hypertension’ |
|E |Wilson disease |
|Case number: | |
|LU8 (ID 1825) | |
| | |
|Clinical Information: | |
|Cirrhosis. Left lateral lesion, ?HCC. Ferritin 1708. AFP 5, CEA 2, CA19-9 42. MRI liver: Established cirrhosis with associated portal | |
|hypertension. radiological features which are considered suspicious for HCC. | |
| | |
|Specimen: | |
|Lesional liver biopsy, left lobe, presumed taken at ablation clinic | |
| | |
|Age: | |
|73 | |
| | |
|Sex: | |
|Male | |
| | |
|Macroscopic description: | |
|Two cores of cream tissue measuring 10mm and 11mm in length. | |
| | |
|Immunohistochemistry: | |
|reticulin, Perls, van Gieson, Hepato, Arginase, glutamine synthetase, | |
| | |
|LU8 | |
|A |HCC and iron |
|B |Dysplastic nodule, cirrhosis and iron deposition |
|C |HCC, cirrhosis and iron deposition |
|D |HCC and cirrhosis |
|E |Hepatocellular adenoma and iron deposition |
|Case number: | |
|LU9 (ID 1672) | |
| | |
|Clinical Information: | |
|History of COCP | |
| | |
|Specimen: | |
|Left lateral liver resection | |
| | |
|Age: | |
|30 | |
| | |
|Sex: | |
|Female | |
| | |
|Macroscopic description: | |
|Incidental 13 mm well-circumscribed haemorrhagic lesion in resection for larger lesion | |
| | |
|Immunohistochemistry: | |
|Nil | |
| | |
|LU9 | |
|A |Epithelioid haemangioendothelioma |
|B |Haemangioma/cavernous haemangioma |
|C |Peliosis hepatis |
|D |Haemangiomatosis |
|C |Angiosarcoma |
|Case number: | |
|LU10 (ID 1671) | |
| | |
|Clinical Information: | |
|A1AT ?extent of fibrosis | |
| | |
|Specimen: | |
|Liver biopsy | |
| | |
|Age: | |
|74 | |
| | |
|Sex: | |
|Male | |
| | |
|Macroscopic description: | |
|single tan core 28mm bisected | |
| | |
|Immunohistochemistry: | |
|PASD, HVG | |
| | |
|LU10 | |
|A |A1AT accumulation |
|B |A1AT accumulation, steatosis and severe fibrosis/cirrhosis |
|C |A1AT accumulation, steatosis and mild fibrosis |
|D |A1AT-like globules due to alcoholic cirrhosis |
|E |Chronic hepatitis with severe fibrosis/cirrhosis |
|Case number: | |
|LU11 (ID 1696) | |
| | |
|Clinical Information: | |
|Abnormal LFTs. ANCA positive. Imaging normal. ? inflammation ? cirrhosis. Additional information - presented 3 weeks ago with 2 day history | |
|of nausea and vomiting; found to have derancged liver function tests. Had taken 2 courses of flucloxacillin from GP. Usual medications: | |
|levothyroxine, simvastatin, atenolol, ranitidine. Bili 100, ALT 8787, Alk phos 193. | |
| | |
|Specimen: | |
|liver core biopsy | |
| | |
|Age: | |
|66 | |
| | |
|Sex: | |
|Male | |
| | |
|Macroscopic description: | |
|2 cores 10mm and 8mm | |
| | |
|Immunohistochemistry: | |
|retic, van Gieson, PASD | |
| | |
|LU11 | |
|A |Chronic hepatitis, possible AIH |
|B |Biliary features most likely drug |
|C |Biliary features most likely biliary tract disease e.g. PSC or large duct obstruction |
|D |Biliary features could be drug can’t exclude biliary tract disease/obstruction |
|E |Cholestatic hepatitis |
|Case number: | |
|LU12 (ID 1584) | |
| | |
|Clinical Information: | |
|Two lesions LLS, left lateral segmentectomy laparoscopically. Larger ?FNH ?adenoma. Smaller ?haemangioma. | |
| | |
|Specimen: | |
|Left lateral laparoscopic segmentectomy | |
| | |
|Age: | |
|45 | |
| | |
|Sex: | |
|Female | |
| | |
|Macroscopic description: | |
|Specimen weight: 187g. Specimen dimensions: Supero-inferior 129mm, Medio-lateral 80mm, Antero-posterior 43mm Capsule intact and shows an area of bulging on | |
|the posterolateral aspect inferiorly which measures 44 x 38 x 25mm. This is intact with a cream, tan, congested appearance. On the anterior aspect 20mm | |
|superior to this area is a second area of bulging 13 x 11mm. Larger lesion segment II, smaller lesion segment II/III. | |
| | |
|Immunohistochemistry: | |
|Glutamine synthetase, Keratin 7, van Gieson | |
| | |
|LU12 | |
|A |Focal nodular hyperplasia |
|B |Hepatocellular adenoma |
|C |Cirrhosis |
|D |Nodular regenerative hyperplasia |
|E |Hepatocellular carcinoma |
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