ࡱ> .0+,-y =&bjbj 7{{+ 88888LLL8 L..2HHH|||-------$0j3-8|||||-88HH4-6$6$6$|`8H8H-6$|-6$6$&'H| &--0..&,4!Z4''48,||6$|||||--#|||..||||4||||||||| : Liver EQA Scheme Circulation LT - Spring 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  HYPERLINK "http://www.virtualpathology.leeds.ac.uk/eqa/specialist/liver/liver_cpd_activities.php" http://www.virtualpathology.leeds.ac.uk/eqa/specialist/liver/liver_cpd_activities.php 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:LT1 Clinical Information:NAFLD. Normal immunoglobulins and weakly positive SMA. Recent rise in LFT's. Alcohol 15 units per week.Specimen:Liver biopsyAge:65Sex:FemaleMacroscopic description:two cores 20mm and 17 mmImmunohistochemistry:Retic, Sirius red.LT1ASteatosis either alcohol or non alcohol relatedBSteatosis alcohol relatedCAutoimmune hepatitis with background steatosisDSteatohepatitis either alcohol or non alcohol relatedESteatohepatitis alcohol related Case number:LT2 Clinical Information: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.Specimen:Liver, core biopsyAge:74Sex:MaleMacroscopic description:A cylinder of tan tissue measuring 24mm plus fragments of similar tissue. Immunohistochemistry:Sirius Red Fast Green, Perls, DPAS, A1ATLT2AAutoimmune hepatitisBBurnt out fatty liver diseaseCFe depositionDAlpha 1 antitrypsin accumulation and Fe depositionEAlpha 1 antitrypsin accumulationCase number:LT3 Clinical Information:Laparoscopic cholecystectomy for gallstones-liver lesion segment 4.Specimen:liver resectionAge:53Sex:MaleMacroscopic description:Wedge of liver 12 x 9 x 2 mmImmunohistochemistry:noneLT3ABile duct adenoma/peribiliary gland hamartomaBMicrohamartomaCVon Meyenberg complexDBile duct hamartomaEAdenocarcinoma deposit Case number:LT4 Clinical Information:HCV and history of heavy alcohol. Fibroscan reassuring but low platelets. ? significant fibrosis.Specimen:liver biopsyAge:67Sex:MaleMacroscopic description:2 cores 12 and 24mm longImmunohistochemistry:EPSRLT4AAIH and fatty liver disease (alcohol related)BHCV and fatty liver disease (alcohol related)CHCVDFatty liver disease (alcohol related)EAIH Case number:LS5 Case number:LT5 Clinical Information:CWT patient. Segment VIII liver lesion biopsy. + background liver biopsy (segment IV). MWA post biopsy. ?HCC. Specimen:Liver biopsy, segment VIII, USG 18GAge:66Sex:MaleMacroscopic description:A core of cream and tan tissue measuring 15mm in length and 1mm in diameter together with fragments measuring 3mm in aggregate. LT5AFocal nodular hyperplasiaBHepatocellular adenomaCHepatocellular carcinomaDBile duct adenomaEFibrolamellar hepatocellular carcinoma Case number:LT6 Clinical Information:CirrhosisSpecimen:Liver explantAge:70Sex:MaleMacroscopic description: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. Immunohistochemistry:none submitted for EQALT6AHepatocellular carcinoma with treatment effectsBHepatocellular carcinomaCFocal nodular hyperplasiaDAdenomaEFibrolamellar carcinoma Case number:LT7 Clinical Information:61 year old male. 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. Specimen:Liver biopsy, USG pluggedAge:61Sex:MaleMacroscopic description:Three tan cores measuring 5, 7 and 17mmImmunohistochemistry:none submitted to EQALT7ABiliary diseaseBDrug induced liver injury DILICVascular disease (outflow obstruction) and DILIDVascular disease (outflow obstruction)EPeliosis hepatis Case number:LT8 Clinical Information:Sepsis of unknown origin. Fever, night sweats, rigor and lethargy. Intravesicle injection BCG for bladder cancer 2 months previously. Deranged liver function tests.Specimen:Liver BiopsyAge:55Sex:MaleMacroscopic description:15mm strand of tissue.Immunohistochemistry:NONELT8AGranulomatous hepatitis ? Drug induced liver injuryBGranulomas most likely sarcoidosisCGranulomas most likely TBDGranulomas, most likely primary biliary cholangitisEGranulomatous inflammation most likely due to BCG Case number:LT9 Clinical Information:Obstructive jaundice secondary to biliary adenoma [sic]Specimen:Native liver, hepatectomyAge:62Sex:FemaleMacroscopic description:Intraductal lesion within CBD, CHD and into R/LHD.Immunohistochemistry:NilLT9AIntraductal Papillary Neoplasia of the Bile Duct (IPNB) or Intraductal TubuloPapillary NeoplasmPNB (ITPN)BIntraductal cholangiocarcinomaCHepatobiliary cystadenocarcinomaDBiliary Intra-epithelial Neoplasia (BilIN)EBiliary papillomatosis Case number:LT10 Clinical Information:High suggestion of fibrosis. Benign biliary stricture ? secondary to chronic pancreatitisSpecimen:Liver biopsyAge:69Sex:FemaleMacroscopic description:Tan core 25mmImmunohistochemistry:HVG LT10AChronic hepatitis differential diagnosis AIH DILI viralBBiliary features secondary to large bile duct obstructionCBiliary features likely biliary tract disease (PBC PSC)DBiliary features likely IgG4 diseaseEMetastatic adenocarcinoma Case number:LT11 Clinical Information:Cardiac cirrhosis? under investigations. Mild constrictuive pericarditis/bicuspid aortic valve with tissue valve replacement. Any evidence of cirrhosis? drug induced liver injury? alcohol related?Specimen:transjugular liver biopsyAge:66Sex:MaleMacroscopic description:liver biopsy - three cores 15mm maxImmunohistochemistry:EVG, CK7LT11ADrug induced liver injuryBAlcohol related liver diseaseCCholestasis/Biliary diseaseDVenous outflow obstructionESickle cell disease Case number:LT12 Clinical Information:Hepatic adenoma 100K Genome project sent fresh. Not sampled for Genome project.Specimen:Left lateral sectionectomy (segments 2 and 3).Age:50Sex:FemaleMacroscopic description:Specimen weight: 411g. Specimen dimensions: Supero-inferior180mm, Medio-lateral 105mm, Antero-posterior 45mm Tumour appearance: Multinodular, irregularly shaped, tan with interspersed vessels, and focal central ?fibrosis., Tumour size: 115mm x 95mm x 45mm Immunohistochemistry:Keratin 7, Glutamine synthetase, van Gieson, ShikataLT12AHepatocellular adenomaBCirrhosisCFocal nodular hyperplasiaDHepatocellular carcinomaENodular regenerative hyperplasia      PAGE \* MERGEFORMAT 1 "-./q G H # U 쵠zbbQb<(hph 86B*OJQJ^JaJph hph 80JOJQJ^JaJ.jhph 8B*OJQJU^JaJph%hph-#B*OJQJ^JaJph%hph 8B*OJQJ^JaJph(hph 8>*B*OJQJ^JaJph)hGhcB*CJOJQJ^JaJph h5>*CJOJQJ^JaJ hQ5>*CJOJQJ^JaJ&hBChc5>*CJOJQJ^JaJ./q J K " # U V c h $Ifgd$If$a$$a$gdGU V b h i ~     . 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