Previous Circulations

Previous circulations.

The main value of the EQA scheme is educational. Since July 2003, liver EQA slides have been available as digital images, and can be reviewed together with the responses of the scheme members and a summary of the meeting discussion.

It is often the case with liver biopsies that there is more than one diagnosis present, and/or that the diagnosis includes both morphological and aetiological components. The liver EQA response form is designed to accommodate this, although it is a challenge to condense the free text responses into diagnostic categories for discussion at the EQA meeting.

Previous circulations with diagnoses are presented here. You can see the preferred diagnosis by clicking the ‘see diagnosis’ button below the information provided on the case. It is best to also read the list of submitted responses of the EQA members, the decision for how to score the case, and discussion of the diagnosis. These are on the ‘EQA meeting with discussion’ powerpoint presentations, ...... The best way to use these is to have both open at the same time.

Circulation W

278 rejection – transplant biopsies taken elsewhere should be referred to the transplant centre for review. 279 no concensus, not scored. Hepatocellular carcinoma 280 fatty liver disease and haemochromatosis 281 metastatic fibrolammelar carcinoma in lymph node 282 primary biliary cirrhosis 283 hepatocellular carcinoma, cirrhosis, haemochromatosis 284 ciliated foregut cyst, background of cirrhosis 285 no concensus, not scored. Unilateral lobar atrophy, underlying cirrhosis, haemochromatosis. 286 cholestasis, likely drug reaction – drug history obtained after further questioning 287 metastatic colorectal carcinoma and embolisation material 288 no concensus, not scored. Biopsy within normal limits – high alk phos was bone origin 289 Hepatocellular carcinoma in slide 1; slide 2 diagnoses not scored.

Circulation X

290 steatohepatitis, probably due to alcohol 291 alpha 1 antitrypsin deficiency, cirrhosis or developing cirrhosis 292 focal nodular hyperplasia 293 liver cell adenoma 294 steatohepatitis, cirrhosis, probably due to NAFLD 295 cholangiocarcinoma 296 probable/definite cirrhosis, haemochromatosis 297 adenocarcinoma, probably metastatic 298 congenital hepatic fibrosis 299 focal nodular hyperplasia 300 hepatitis/chronic hepatitis, ? drug related 301 no concensus, not scored. Original diagnosis – end stage non-cirrhotic portal hypertension

Circulation Y

302 Granulomatous inflammation, BCG/TB 303 hepatitis C and transfusion haemosiderosis 304 no consensus, not scored, PBC ? with AIH overlap 305 Budd Chiari syndrome/venous outflow obstruction 306 hepatobiliary cystadenoma, mesenchymal stroma 307 acute hepatitis with bridging necrosis, probably autoimmune 308 Primary biliary cirrhosis 309 cholestasis, drug-induced (flucloxacillin) 310 hepatitis, autoimmune 311 cirrhosis, haemochromatosis, Hepatocellular carcinoma 312 hepatocellular carcinoma, cirrhosis 313 mild chronic hepatitis C

Circulation Z

314 biliary cystadenocarcinoma 315 metastatic adenocarcinoma (colorectal); nodular hyperplasia, sinusoidal obstruction syndrome related to oxaliplatin. 316 cholestasis, probably drug reaction (antibiotics) 317 cirrhosis, steatohepatitis, alcohol 318 primary biliary cirrhosis 319 hepatocellular carcinoma, cirrhosis 320 hepatocellular carcinoma 321 cholestatic hepatitis, c/w drug induced liver injury – mesalazine, autoimmune features 322 no consensus, not scored. Granulomatous inflammation, AIH and steatosis. 323 alcoholic steatohepatitis, central sclerosing hyaline necrosis 324 venous outflow obstruction, veno-occlusive disease 325 focal nodular hyperplasia

Circulation A1

326 autoimmune hepatitis (acute) with confluent necrosis 327 no consensus, not scored. Nodular regenerative hyperplasia 328 metastatic carcinoma – papillary carcinoma of thyroid 329 amyloid 330 no consensus, not scored. venous outflow obstruction/ Budd Chiari Syndrome 331 cirrhosis, haemochromatosis 332 focal nodular hyperplasia 333 hepatitis (acute, bridging necrosis) autoimmune 334 mild chronic hepatitis B and steatosis 335 iron overload, transfusional siderosis 336 hepatobiliary cystadenoma, mesenchymal stroma 337 cirrhosis, Hepatocellular carcinoma Circulation B1

338 hepatitis, autoimmune 339 solitary biliary cyst 340 hepatitis C, bridging fibrosis/developing cirrhosis/Ishak stage 5 341 No consensus, not scored. Epithelioid haemangioendothelioma, sarcomatous 342 Early Hepatocellular carcinoma 343 Granulomatous inflammation, sarcoidosis 344 nodular regenerative hyperplasia/ non-cirrhotic portal hypertension 345 case not scored. Inflammatory (prev=telangiectatic) adenoma 346 hydatid cyst 347 severe acute hepatitis with panacinar necrosis (aetiology not scored) 348 hepatitis with granulomas, c/w TB 349 acute hepatitis with bridging necrosis, c/w autoimmune

Circulation C1

350 metastatic adrenal cortical carcinoma 351 cholestasis with ductopaenia (PSC) 352 chronic biliary disease, consistent with PBC 353 cirrhosis, hepatitis C 354 steatohepatitis, NASH 355 PBC, steatosis 356 cholestatic hepatitis, drug related 357 acute hepatitis with bridging necrosis, autoimmune 358 steatohepatitis, cirrhosis, NASH 359 autoimmune hepatitis 360 granulomatous inflammation, BCG 361 alcoholic steatohepatitis