Liver EQA Scheme Circulation D1 Summer 2011
Liver EQA Scheme Circulation LO – Summer 2016
MCQ version – available for non-EQA members who will be delegates at the Liver Update meeting on 6th October 2016
Case LO1 Age 68, Male
Raised ferritin. Raised Transferrin Sat. Haemochromatosis screen negative.
?iron overload secondary to variant haemochromatosis.
|a |Cirrhosis due to genetic haemochromatosis |
|b |steatohepatitis |
|c |Chronic hepatitis and cirrhosis |
|d |Cirrhosis due to haemosiderosis |
|e |Cirrhosis, both steatohepatitis and iron deposition |
Case LO2 Age 38, Male
Chronic inactive hepatitis. B carrier. Rise ALT. Reactivation or rogue mutation of virus? Additional laboratory information HepB PCR positive, HBSag +ve, HBeAg -ve (+ve in past), HepC -ve. ALT 59 iu/l, ALP 51 iu/l
|a |Chronic hepatitis B, mild fibrosis |
|b |Mild acute hepatitis B |
|c |Suspect PSC, not convincing hepatitis B |
|d |Consistent with chronic viral hepatitis |
|e |Mild steatohepatitis, no hepatitis B |
Case LO3 Age 52, Male
Presumed cirrhosis on imaging. Risk factors for liver disease: excess alcohol, overweight. Possible SLE therefore AIH?
|a |Autoimmune hepatitis/PBC overlap |
|b |Cirrhosis, chronic hepatitis |
|c |Cirrhosis – evidence of both steatohepatitis and autoimmune hepatitis |
|d |Steatohepatitis – alcoholic and/or non-alcoholic |
|e |Chronic hepatitis, consistent with AIH |
Case LO4 Age 79, Male
Two liver lesions - one malignant on MR, but not HCC on EASL. ? nature.
Ablation pre-treatment biopsy (targeted liver biopsy)
|a |High grade dysplastic nodule |
|b |Hepatocellular carcinoma |
|c |Hepatoid carcinoma ? metastasis |
|d |Inflammatory adenoma |
|e |Carcinoma primary or metastatic, or melanoma needs IHC |
|Case LO5 Age 49, Male |
|Liver transplant for alcoholic liver disease. |
|Liver explant - Cirrhotic liver with 5mm grey/white lesion visible at capsular surface right lobe liver |
| |
|a |Bile duct adenoma |
|b |Peribiliary gland hamartoma |
|c |Focal nodular hyperplasia |
|d |Small peripheral cholangiocarcinoma |
|e |Hepatocellular carcinoma |
Case LO6 Age 30, Female
A segment of liver measuring 60 x 38 x 32mm. Single pale circumscribed lobulated lesion 35 x 32 x 27mm. 3mm from surgical margin
|a |Hepatocellular carcinoma, well differentiated |
|b |Nodular regenerative hyperplasia |
|c |Hepatocellular adenoma, inflammatory type |
|d |Localised cirrhotic nodule |
|e |Focal nodular hyperplasia |
Case LO7 Age 72, Female
Liver transplant for hepatitis C and HCC 11 years ago. Post transplant hepatitis C PCR positive, genotype not known. Type II diabetes High ALT.
Biopsy for stage of fibrosis and ? cause of high ALT.
|a |steatosis |
|b |Chronic viral hepatitis |
|c |Acute rejection and mild hepatitis C |
|d |Recurrent hepatitis C and steatohepatitis |
|e |Steatohepatitis ? alcohol |
Case LO8 Age 55, Female
Marked derangement of LFTs. Atypical Hx. Progressive jaundice. SMA positive, Hep E -ve.
|a |Chronic hepatitis and cirrhosis, probably drug induced |
|b |Severe hepatitis, acute or acute-on-chronic, probably autoimmune |
|c |Acute hepatitis ? drug related, exclude viral |
|d |Cirrhosis, steatohepatitis |
|e |Overlap autoimmune hepatitis and PBC |
Case LO9 Age 54, Female
RUQ pain, vomiting and jaundice. Partially resolved with recurrence of jaundice and deranged LFTs. ?autoimmune hepatitis. ANA and SMA positive, Hep E negative.
|a |Chronic active hepatitis with scarring |
|b |Cholangiopathy with cholestasis and necrosis |
|c |AIH and PSC overlap |
|d |Acute hepatitis ? drug, ? viral, ?? AIH |
|e |Autoimmune hepatitis, active disease |
Case LO10 Age 51, Female
abnormal liver function tests. elevated alk p'ase. positive AMA; elevated IgM IgG normal.
|a |Primary biliary cholangitis, early stage |
|b |Primary sclerosing cholangitis, early stage |
|c |Chronic hepatitis, ? autoimmune |
|d |Ductopenic chronic rejection |
|e |Chronic hepatitis, possible PBC or PSC |
Case LO11 Age 21, Male
Right hemihepatectomy. 1281g hemi-hepatectomy specimen containing two tumours with variable fibrosis/ calcification, 129mm in maximum dimension. No macroscopic involvement of vessels. 5mm from resection margin. One uninvolved cystic duct node.
|a |Dysplastic nodule, high grade |
|b |Neuroendocrine carcinoma, metastatic |
|c |Hepatocellular carcinoma, fibrolamellar type |
|d |Metastatic renal cell carcinoma oncocytic |
|e |Hepatocellular adenoma, beta catenin mutated |
Case LO12 Age 76, Male
hepatitis B, not known to be cirrhotic, but on HCC surveillance due to age and viral load. USS showed 4cm lesion. AFP is 7. Right hepatectomy 637g, containing 50mm subcapsular white solid tumour adjacent to surgical margin. Solid material in portal vein. Meets EASL criteria for HCC.
|a |Hepatocellular adenoma, clear cell type |
|b |Ischaemic change in focal nodular hyperplasia |
|c |Hepatocellular carcinoma, clear cell, needs IHC to confirm |
|d |Favour renal cell carcinoma over hepatocellular |
|e |Metastatic melanoma |
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