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Slide Digitization by:

Sdn Bhd

September 7th, 2019  (Liver Pathology)

Digital Slide Seminar 1:

Approach to Liver Biopsy with Focal Liver Lesions

Professor Aileen Wee

Case 1: An Intraductal Papillary Lesion

  • 65 year-old Chinese women

  • Hepatitis B carrier

  • 10 years ago: Right hemicolectomy for stage 2 colonic adenocarcinoma; no adjuvant therapy

  •  Asymptomatic 

  • Serum CEA rose from 3.0 to 9.6 µg/L over 3 months

  • Liver panel normal

  • PET scan: Nodule at hilum of liver. Intrahepatic bile ducts not dilated.

  • Impression: Hepatocellular carcinoma (HCC) versus colonic metastasis.   

  • Liver lobectomy

 

 

Case 2: An Intraductal Papillary Lesion

  • 72 year-old Chinese man

  • Hepatitis B carrier

  • Diabetes mellitus, hypertension

  • Presents with painless obstructive jaundice

  • Anti-HBc positive

  • AFP 3.7 µg/L, CEA 3.7 µg/L, CA19-9 47 u/ml

  • PTC insertion

  • Biopsy through PTC

  • Diagnostic laparoscopy: "Cirrhosis"

  • Partial hepatectomy

 

Case 3: An Intrahepatic Mass

  • 50 year-old Chinese man

  • Asymptomatic

  • No clinical history or laboratory results of note

  • CT scan of abdomen: Incidental solitary 5-cm mass in posterior aspect of right lobe of non-cirrhotic liver

  • Consult case of hepatic resection

  • "Strange-looking HCC in the liver"

Case 4: A Potential Pitfall

  • 45 year-old Chinese man

  • Serum tumor markers negative

  • Hepatitis virus markers negative

  • CT scan of abdomen: 6 cm mass in a non-cirrhotic liver

  • Percutaneous needle core biospy

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Case 5: A Great Mimic

  • 45 year-old Chinese women

  • Small bowel surgery 2 years ago

  • Multiple liver nodules

  • Fine needle aspiration cytology and needle core biopsy of liver lesion

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Case 6: A Young Woman with Perisinusoidal Fibrosis

May 2012

  • 21 year-old women

  • Bruising, menorrhagia and abdominal distension x 5 months

  • Daily fevers of 39°C and night sweats

  • Weight loss

  • Hepatosplenomegaly with ascites

  • Hb of 9g/dl, white cell count of 4.0 x 10⁹/l, platelet count of 34 x 10⁹/l

  • Serology for hepatitis B, C, HIV, CMV, and EBV were negative

  • Anti-nuclear antibody and anti-double stranded DNA were negative

  • Lactate dehydrogenase was within normal limits

  • Direct Coombs test was negative

  • Bone marrow aspiration was not conclusive

June 2012

  • Splenectomy - splenomegaly and worsening thrombocytopenia

  • Histopathology: "Lymphoid proliferation"

October 2012

  • Worsening jaundice with conjugated hyperbilirubinemia

  • Fibroscan score of F4

  • Liver biopsy: Cholestatic liver injury with cirrhosis

January 2013 (Singapore)

  • Worsening jaundice, ascites, fever and night sweats

  • Menorrhagia and gingival bleeding

  • Cachexia, scleral icterus, ascites, hepatomegaly & inguinal lymphadenopathy

  • Repeat liver biopsy