—  SPECIALTY CONFERENCE  — Liver Pathology Tuesday, March 4, 2008 , 7:30 PM Convention Center 102/104/106 Click the button above to add this event to your Itinerary Planner... Moderator: ELIZABETH M. BRUNT Washington University School of Medicine St. Louis, MO 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: Andrew Clouston Clinical Summary: The patient was a 40 year old dentist with a history of alcoholic liver disease and decompensated cirrhosis. He was transplanted and the section is from the explant. Apart from some acquired red cell spurring requiring 2 transfusions in the preceding 12 months, there was no history of recurrent transfusions or iron supplementation. Testing for HFE mutations was performed at a later time. 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 2 Submitted by: Christine Janney - Saint Louis University, Saint Louis, MO Clinical Summary: The patient, a 36 year old woman, was referred to our center for evaluation and possible resection of a painful large hepatic mass, located in the posterior right lobe. She first noted right upper quadrant abdominal pain 2 months earlier; at that time an ultrasound study demonstrated a predominantly cystic area measuring 6 .3cm in the right lobe of the liver. A subsequent CT scan was initially interpreted as a subcapsular hematoma of the liver. The pain was well-controlled with nonprescription pain medications. One week prior to referral, the pain became worse, and the patient went to an outside hospital. Repeat ultrasound showed that the heterogeneous, cystic and solid lesion now measured at least 11 cm. The repeat CT scan and an MRI were interpreted as showing an encapsulated, predominantly solid mass with cystic, blood-containing regions, c/w an adenoma with hemorrhage, which was thought responsible for the previous subcapsular hematoma. She was referred to St. Louis University Medical Center for resection. In addition to RUQ pain, the patient complained of fever spiking to 102 degrees F, chills, nausea, vomiting and a 5 pound weight loss over the prior 2 weeks. Past medical history was significant for 2 cesarean sections, post partum depression, and oral contraceptive use. She did not smoke or drink alcohol. Her last menstrual period was 2 weeks prior to referral. On physical examination, the patient had hepatomegaly and was tender to right upper quadrant palpation. The physical exam was otherwise within normal limits. Laboratory values on admission included a white blood cell count of 14,000, hemoglobin 11, hematocrit 33, platelets 121, platelets 121,000 and albumin 2.9. All other laboratory values were normal. Following preoperative assessment and review of radiographic studies, the patient underwent a right hepatectomy and resection of adherent diaphragm with prosthetic repair. The patient did well postoperatively and was discharged on postoperative day 5. Case 2 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 2 - Figure 5 Case 2 - Figure 6 Case 2 - Figure 7 Case 2 - Figure 8 Case 3 Submitted by: Hala R. Makhlouf - Armed Forces Institute of Pathology, Washington, DC Clinical Summary: This 28 year old woman presented with a solitary liver mass. She had a history of calcified hepatic nodules, believed to be calcified hemangioma, since childhood (age 4). There was a history of contraceptive steroid use. Imaging studies demonstrated a 15 cm circumscribed multi-lobulated lesion arising from segments IV, V and VI of liver. Serum alpha-fetoprotein was normal. Serology for hepatitis A, B, and C was negative. A trisegmentectomy (segments IVB, V, VI) with a wedge resection of a separate focal nodular hyperplasia from segment VII was performed. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer 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: Cheryl M. Coffin - Primary Children's Medical Center, University of Utah, Salt Lake City, Utah Clinical Summary: A 14-year old girl was found to have a mass in the liver. She underwent an extended right hepatic lobectomy. She was alive and well twenty years after initial diagnosis. Case 4 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 Case 4 - Figure 7 - A1ACT Case 4 - Figure 8 - p53 If there are glass slides for a conference, they will be available for study in the microscope room in the Convention Center Room 101 for participants who wish to review them prior to the evening session. 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. However, we will provide a booklet at the meeting which will have a page for each Specialty Conference, listing the names of speakers and space for the important "take home messages".