Liver EQA Scheme Circulation D1 Summer 2011



Liver EQA Scheme Circulation H1 - Spring 2013

Educational Participant MCQ answer sheet

Welcome to the electronic submission site for educational participants in liver EQA circulation H1.

This uses the 12 cases in liver EQA circulation H1 as liver CPD for non-EQA members. It is NOT a form of quality assurance. The cases will be discussed at the BSG/BDIAP liver meeting on 28th November 2013.

You can view the cases either using the powerpoint of photomicrographs, or the digital virtual slides, or both.

Please identify the single most appropriate response from the list of 5 or 6 alternatives.

The list of responses are derived from the actual responses in the EQA circulaion.

Please submit your response by Tuesday 26th November.

The cases will be discussed during the BSG/BDIAP liver meeting on 28th November.

After the meeting, you will receive your result, and a CPD certificate.

Case H1/410 Age 60, Male

Choledochal cyst of left liver

120x80x50mm portion of L lobe well-defined central white solid & cystic lesion measuring 110mm max.

a. mucinous cystic neoplasm

b. intraductal papillary neoplasia

c. cystadenocarcinoma

d. biliary papillomatosis

e. borderline cystadenoma

f. papillary adenoma

Case H1/411 Age 39, Female

Liver Lesion seg VI

Wedge of liver 8x6.5x6cm, weighing 136g

a. inflammatory adenoma

b. focal nodular hyperplasia

c. well differentiated hepatocellular carcinoma

d. nodular regenerative hyperplasia

e. fibrolamellar carcinoma

Case H1/412 Age 65, Male

Colorectal ca post chemo

Wedge of liver 28x26x8mm with 11mm pale nodule under the capsule

a. solitary necrotic nodule

b. sclerosed haemangioma

c. complete response in metastatic adenocarcinoma

d. scar, old infarct

e. fibrous nodules, NOS, not tumour

Case H1/413 Age 63, Female

Abnormal Liver function tests. History of Sarcoidosis ? Steatosis ? Fibrosis

3 cores of liver combined length 40mm

a. granulomas, probably tuberculosis and fatty liver

b. granulomas, probably PBC and fatty liver

c. steatohepatitis with granulomatous hepatitis

d. granulomas consistent with sarcoidosis and fatty liver

e. steatosis and PBC

Case H1/414 Age 79, Female

Lesion in left lobe of liver and CBD stone

Circumscribed lesion 50x45x45mm and is red brown with central necrosis. CBD stones confirmed (Also Shikata stain)

a. hepatocellular carcinoma, cirrhosis, hepatitis B

b. hepatocelllular carcinoma, hepatitis B, not cirrhotic

c. Liver cell adenoma, hepatitis B, not cirrhotic

d. neurendocrine tumour and hepatitis B

e. differential HCC, adenoma or neurendocrine tumour, hepatitis B, not cirrhotic

Case H1/415 Age 72, Female

Right Liver Normal. Left Liver diffusely abnormal with enlarged hilar nodes

Left Liver - appears cirrhotic 145x110x60mm N.B. Right liver NOT Cirrhotic on Biopsy

a. oriental cholangiohepatitis

b. biliary, duct-centric inflammation, ? cause

c. IgG4 disease

d. biliary disease, probably PBC

e. lymphoma

f. biliary disease, probably PSC

Case H1/416 Age 69, Female

Raised alkaline phosphatase and Gamma GT, AMA Positive

(also trichrome and retic stains)

Three cores of liver

a. Primary biliary cirrhosis

b. chronic inflammation NOS

c. ? underlying chronic biliary disease, needs more clinical details

d. chronic active hepatitis

e. peliosis hepatis

Case H1/417 Age 58, Male

Jaundice ? Cause

1 core 12 mm (also VG stain)

a. cholestasis, most likely bile duct obstruction

b. acute cholestatic hepatitis

c. graft v. host disease

d. cholestasis, most likely sepsis

e. cholestasis, most likely PSC

f. cholestasis, most likely drug related

Case H1/418 Age 67, Male

Rectal carcinoma deranged LFT's, cirrhosis and ascites ? Metastatic lesion

Liver cores 14 & 10mm long

a. adenocarcinoma

b. sinusoidal obstruction syndrome

c. large bile duct obstruction

d. amyloid

e. haemangioma

Case H1/419 Age 35, Male

Hepatitis C. Fibrosis on fibroscan.

Two cores of liver (also retic stain)

a. hepatitis C, mild fibrosis

b. hepatitis C, bridging fibrosis

c. hepatitis C, cirrhosis

d. hepatitis B, bridging fibrosis

e. steatohepatitis and hepatitis C

Case H1/420 Age 81, Female

Gastric GIST (downstaged with Gli vec) liver resection for lesion L lateral segment

Wedge of liver 110x70x35 containing one well defined beige tumour 30mm

(+ EVG stain)

a. fibrous nodule, consistent with GIST postGlivec

b. solitary fibrous nodule

c. sclerosed haemangioma

d. mesenchymal hamartoma

e. fibrosis or scar NOS

Case H1/421 Age 58, Female

Deranged liver function tests. Positive anti-smooth muscle antibody ? Autoimmune hepatitis

Three cores and some fragments

a. primary biliary cirrhosis

b. autoimmune hepatitis

c. acute hepatitis with confluent necrosis, probably drugs

d. severe autoimmune hepatitis, probably cirrhosis

e. consistent with autoimmune hepatitis, but differential other causes of hepatitis

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