Liver EQA – educational participant’s response sheet

Use this sheet to keep a hard copy of your answers, then submit using the surveymonkey link. Results and CPD certificates will be issued for electronic submissions before 6th December.

Circulation F1, Spring 2012

Case 386 39 M

Known hep B positive Chinese male. HBs and e antigen positive. HBV DNA 9.7 Not obese. AFP 3. To assess inflammation and fibrosis

no fibrosis (includes equivocal, insignificant)
definite fibrosis, no bridging
fibrosis with bridging, without parenchymal nodularity
fibrosis and parenchymal nodularity
insufficient for assessment

Case 387 78 F

ALT – recent course of flucloxacillin and on aspirin. ANF +ve

Chronic hepatitis NOS
Autoimmune hepatitis
Drug reaction to flucloxacillin
Autoimmune hepatitis or drug reaction
Biliary disease
Don’t know

Case 388 26 M

Acute hepatitis. Likely secondary to drug toxicity (body builder: on androgenic compounds). Negative viral and autoimmune screen.

Morphology:

Bland cholestasis
Acute hepatitis with briging necrosis
Mild chronic hepatitis
Cholestatic hepatitis
Don’t know

Most likely aetiology:

Consistent with effect of drugs
Viral hepatitis
Large bile duct obstruction
Hepatitis – could be due to viral, drug, or autoimmune
Don’t know

Case 389 40 M

Clinical information supplied: Cirrhosis

Aetiology:

Non-specific
Alcoholic
Hepatitis B
Hepatitis C
Don’t know

Stage of disease:

no fibrosis (includes equivocal, insignificant)
definite fibrosis, no bridging
fibrosis with bridging, without parenchymal nodularity
fibrosis and parenchymal nodularity
insufficient for assessment

Case 390 55 F

Antimitochondrial antibody +ve 1:1600. Anti SM +ve 1:100. ? overlap syndrome ALP 843, ALT 555, BIli 15

Acute hepatitis
Primary biliary cirrhosis and autoimmune hepatitis overlap
Primary biliary cirrhosis
Autoimmune hepatitis
Primary sclerosing cholangitis and autoimmune hepatitis overlap
Don’t know

Case 391 37 M

Hepatitis C positive. Abnormal LFTs. For staging hep C before antiviral treatment.

Stage of disease:

no fibrosis (includes equivocal, insignificant)
definite fibrosis, no bridging
fibrosis with bridging, without parenchymal nodularity
fibrosis and parenchymal nodularity
insufficient for assessment

Case 392 25 F

Long medical summary attached on hard copy

Acute hepatitis
Chronic hepatitis and cirrhosis NOS
Wilson’s disease
Metabolic disease ? what
Alcoholic liver disease
Chronic hepatitis B
Don’t know

Case 393 76 M

Mass right lobe of liver, likely HCC

Definite HCC
Probable HCC, requires immunohistochemistry confirmation
Tumour present ? what, needs immunohistochemistry
Dysplastic nodule, no malignancy.
Don’t know

Background liver tissue:

Fatty liver disease
Cirrhosis NOS
Suspect alpha 1 antitrypsin deficiency
Don’t know

Case 394 58 M

HCV genotype, RNA –ve after treatment

Chronic hepatitis NOS
Chronic hepatitis, consistent with hepatitis C
Consistent with hepatitis C but exclude lymphoma
Chronic hepatitis, ground glass hepatocytes, ? hepatitis B
Probable Non- Hodgkin’s lymphoma
Don’t know

Stage of disease:

no fibrosis (includes equivocal, insignificant)
definite fibrosis, no bridging
fibrosis with bridging, without parenchymal nodularity
fibrosis and parenchymal nodularity
insufficient for assessment

Case 395 39 F

Hepatitis C virus positive.

Stage of disease:

no fibrosis (includes equivocal, insignificant)
definite fibrosis, no bridging
fibrosis with bridging, without parenchymal nodularity
fibrosis and parenchymal nodularity
insufficient for assessment

Case 396 68M

Palliative resection of T4 rectosigmoid carcinoma. Metastasis seen on liver surface and biopsied.

Wedge biopsy with white area 6mm diameter

Bile duct adenoma
? bile duct adenoma, needs immunos
Peribiliary gland hamartoma
Metastatic adenocarcinoma
Von Meyenberg complex
Don’t know

Case 397 59 F

? cholangiocarcinoma

Left hemihepatectomy 390g. Yellow lesion, 50mm maximum dimension.

Mesenchymal hamartoma
Adenoma
Xanthogranulomatous inflammation
Angiomyolipoma
Infarcted liver
Inflammatory pseudotumour
Inflammatory myofibroblastic tumour
Cholangiocarcinoma
Langerhan’s cell histiocytosis
Pecoma
Don’t know

That’s all.

Now copy your answers into the surveymonkey response sheet , using the link on the Virtualpathology liver CPD website.

Thank you for taking part in this pilot exercise. The response sheet will include additional questions about this, so that we can assess its usefulness and how it could be improved. Any feedback will be appreciated,

Judy Wyatt

National Liver Histopathology EQA Scheme organiser