—  SPECIALTY CONFERENCE  — Liver Pathology Monday, February 28, 2011, 7:30 PM CC 007 A-D Just Some Good Cases Moderator: KENNETH BATTS Abbott Northwestern Hospital and Virginia Piper Cancer Institute Minneapolis, MN Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: Laura Lamps, University of Arkansas, Little Rock, AR Dhanpath Jain, Yale University, New Haven, CT Lawrence Burgart, Abbott Northwestern Hospital, Minneapolis, MN Dale Snover, Fairview Southdale Hospital, Edina, MN Clinical histories are displayed below. For the fastest viewing of virtual slides, click: under each thumbnail image below. You must have Aperio ImageScope installed on your PC. If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy:   Or, click on slide thumbnail images to view each slide in a Web-based slide viewer, which is somewhat slower. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 Submitted by: Laura W. Lamps - Clinical Summary: The patient was a 60 year old white man with rheumatoid arthritis. He presented to a local physician with new onset jaundice and thrombocytopenia. A liver biopsy was performed, and the pathologist thought the biopsy had features of chronic biliary disease, but could not classify the biliary disease further. He was evaluated in the hospital for a week. He then presented several days after discharge to a hepatologist to whom he had been referred. He had worsening ascites, acute renal failure, and mild encephalopathy. His bilirubin was 43 mg/dl. Review of his complete medical records at that time, which had been previously unavailable, gave a vague history of noncirrhotic portal hypertension. An MRI scan subsequently showed chronic portal vein thrombosis, multiple superior mesenteric vein and splenic vein collaterals, and mild irregularities of the common bile duct. His bilirubin rose to greater than 60 mg/dl, and other labs included an AST of 418 IU/L, ALT 423 IU/L, and alkaline phosphatase of 202 IU/L. A second liver biopsy was performed. Case 1 - Figure 1 Case 1 - Figure 2 Case 1 - Figure 3 Case 1 - Figure 4 Case 1 - Figure 5 Case 1 - Figure 6 Case 1 - Figure 7 Case 1 - Figure 8 Case 2 Submitted by: Dhanpat Jain - Clinical Summary: Patient is a 55 year old male who presented with fever and Jaundice. Pertinent Laboratory Data: Transaminases (AST and ALT) were elevated in about 250 U range. Antinuclear antibodies were weakly positive (ANA 1:40), Anti smooth muscle antibodies (SMA), antimitochondrial antibodies (AMA), liver kidney and microsomal (LKM) antibodies, serology for hepatitis (A, B and C) were all negative. Liver biopsy was performed. Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Trichrome Case 2 - Figure 5 Trichrome Case 3 Submitted by: Lawrence J. Burgart - Clinical History: Thirty-six year old woman presented with upper abdominal fullness and acute onset of right upper quadrant pain. Ct scan showed a 10 cm complex cystic and solid mass with hemorrhage in posterior right hepatic lobe. Case 3 - Figure 1 Case 3 - Figure 2 Case 3 - Figure 3 Case 3 - Figure 4 Case 3 - Figure 5 Case 3 - Figure 6 Case 4 Submitted by: Dale C. Snover - Clinical Summary: 64 year old male who presented with an acute febrile illness with abdominal and back pain and headache. Antibiotics were given but he continued to deteriorate. CT and ultrasound showed a thickened gallbladder and gallstones and the possibility of cholecystitis and choledocholithiasis was considered. At that point he had developed abnormal liver function tests. CT of the head was unremarkable. He was admitted on October 27 and underwent cholecystectomy and wedge liver biopsy on November 6. During his course he developed a peripheral blood lymphocytosis and right middle lobe atelectasis. The lymphocytes were initially described as reactive appearing, however over time increased basket cells with atypical lymphocytes were reported. ERCP was reported to be normal and hepatitis A, B and C studies were negative. Pertinent Laboratory Data: October 27: ALT 270, AST 225, Alk Phos 217, T. Bili 1.6, Hgb 13.3 October 31: ALT 326, AST 310, Alk Phos 495, T. Bili 4.6, Hgb 12.9, WBC 16.9 X 10^9/L (12% Neutrophils, 88% lymphocytes) November 4: ALT 209, AST 246, Alk Phos 600, T. Bili 3.0, Hgb 10.9, WBC 26.7 X 10^9/L (13% Neutrophils, 78% lymphocytes, 9% others) [Normals: ALT 0-70 U/L, AST 0-55 U/L, Alk Phos 40-150 U/L, T. Bili 0.2 – 1.3 mg/dl, Hgb 13.3 – 17.7 X 10^9/L , WBC 4.0 – 11.0 X 10^9/L ] Case 4 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting.