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Liver histopathology EQA Scheme
Circulation LT
Spring 2019
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Case LT1 65F NAFLD. Normal immunoglobulins and weakly positive SMA. Recent rise in LFT's. Alcohol 15 units per week. Also reticulin and Sirius Red.
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LT1
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LT1
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LT1
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LT1
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LT1
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LT1 Sirius red
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LT1
LT1 Sirius red
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LT1 reticulin
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LT1
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
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Case LT2 74M 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. Additional stains: Sirius Red Fast Green, Perls, DPAS, A1AT.
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LT2
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LT2
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LT2
Sirius red fast green
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LT2
Perls
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LT2
PASD
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LT2
Alpha 1 antitrypsin
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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
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Case LT3 53M Laparoscopic cholecystectomy for gallstones-liver lesion segment 4. Wedge of liver 12 x 9 x 2 mm.
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LT3
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LT3
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LT3
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LT3
A Bile duct adenoma/peribiliary gland hamartoma
B Microhamartoma
C Von Meyenberg complex
D Bile duct hamartoma
E Adenocarcinoma deposit
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Case LT4 67M HCV and history of heavy alcohol. Fibroscan reassuring but low platelets. ? significant fibrosis. Additional stains: EPSR.
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LT4
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LT4
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LT4
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LT4
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LT4
Elastic picro Sirius red
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LT4
Elastic picro Sirius red
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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
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Case LT5 66M Segment VIII liver lesion biopsy. + background liver biopsy (segment IV). Microwave ablation post biopsy. ?HCC. No additional stains submitted.
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LT5
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LT5
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LT5
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LT5
Background liver
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LT5
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Case LT5 66 Segment VIII liver lesion biopsy. + background liver biopsy (segment IV). Microwave ablation post biopsy. ?HCC. No additional stains submitted.
LT5
A Focal nodular hyperplasia
B Hepatocellular adenoma
C Hepatocellular carcinoma
D Bile duct adenoma
E Fibrolamellar hepatocellular carcinoma
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Case LT6 70 Cirrhosis. Specimen: Liver explant. 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. Additional stains: None submitted for EQA.
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LT6
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LT6
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LT6
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LT6
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LT6
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Case LT6 70 Cirrhosis. Specimen: Liver explant. 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. Additional stains: None submitted for EQA.
LT6
A Hepatocellular carcinoma with treatment effects
B Hepatocellular carcinoma
C Focal nodular hyperplasia
D Adenoma
E Fibrolamellar carcinoma
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Case LT7 M71 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. Liver biopsy, USG plugged. Three tan cores measuring 5, 7 and 17mm. Additional stains: None submitted to EQA.
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LT7
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LT7
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LT7
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LT7
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LT7
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Case LT7 M71 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. Liver biopsy, USG plugged. Three tan cores measuring 5, 7 and 17mm. Additional stains: 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
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Case LT8 55M Sepsis of unknown origin. Fever, night sweats, rigor and lethargy. Intravesicle injection BCG for bladder cancer 2 months previously. Deranged liver function tests. Additional stains: NONE.
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LT8
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LT8
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LT8
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Case LT8 55M Sepsis of unknown origin. Fever, night sweats, rigor and lethargy. Intravesicle injection BCG for bladder cancer 2 months previously. Deranged liver function tests. Additional stains: 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
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Case LT9 F62 Obstructive jaundice secondary to biliary adenoma [sic]. Native liver, hepatectomy. Macroscopic description: Intraductal lesion within CBD, CHD and into R/LHD. Additional stains: Nil.
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LT9
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LT9
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LT9
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LT9
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LT9
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Case LT9 F62 Obstructive jaundice secondary to biliary adenoma [sic]. Native liver, hepatectomy. Macroscopic description: Intraductal lesion within CBD, CHD and into R/LHD. Additional stains: 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
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Case LT10 F69 High suggestion of fibrosis. Benign biliary stricture ? secondary to chronic pancreatitis. Additional stains: HVG.
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LT10
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LT10
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LT10
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LT10
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LT10
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LT10
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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 LT10 F69 High suggestion of fibrosis. Benign biliary stricture ? secondary to chronic pancreatitis. Additional stains: HVG.
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Case LT11 66M Cardiac cirrhosis? under investigations. Mild constrictive pericarditis/bicuspid aortic valve with tissue valve replacement. Any evidence of cirrhosis? drug induced liver injury? alcohol related? Specimen: Transjugular liver biopsy - three cores 15mm max. Additional stains: EVG, CK7.
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LT11
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LT11
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LT11
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LT11
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LT11
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LT11
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LT11 EVG
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LT11 EVG
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LT11 CK7
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LT11 CK7
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LT11 CK7
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LT11
A Drug induced liver injury
B Alcohol related liver disease
C Cholestasis/Biliary disease
D Venous outflow obstruction
E Sickle cell disease
Case LT11 66M Cardiac cirrhosis? under investigations. Mild constrictive pericarditis/bicuspid aortic valve with tissue valve replacement. Any evidence of cirrhosis? drug induced liver injury? alcohol related?
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Case LT12 50F Hepatic adenoma 100K Genome project sent fresh. Not sampled for Genome project. Specimen: Left lateral sectionectomy (segments 2 and 3). Multinodular, irregularly shaped, tan with interspersed vessels, and focal central ?fibrosis., Tumour size: 115mm x 95mm x 45mm. Additional stains: Keratin 7, Glutamine synthetase, van Gieson, Shikata.
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LT12
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LT12
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LT12 van Gieson
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LT12 LT12 Shikata
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LT12 Shikata
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LT12 CK7
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LT12 LT12 glutamine synthetase
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LT12 glutamine synthetase
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LT12
A Hepatocellular adenoma
B Cirrhosis
C Focal nodular hyperplasia
D Hepatocellular carcinoma
E Nodular regenerative hyperplasia
Case LT12 50F Hepatic adenoma 100K Genome project sent fresh. Not sampled for Genome project. Specimen: Left lateral sectionectomy (segments 2 and 3). Multinodular, irregularly shaped, tan with interspersed vessels, and focal central ?fibrosis., Tumour size: 115mm x 95mm x 45mm.
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The End