Female 73 years

Markedly elevated liver enzymes (ALT, AST); elevated IgG; ANA 1:640; positive anti-smooth msucle antigen. Sent ? AIH ? cirrhosis.

Specimen: Liver core biopsy (transjugular).

Macroscopic description:
2 cores of liver 12mm 9mm.

Immunohistochemistry:
H&E, Retic, Massons Trichrome, PAS slides sent.

Male 71 years

Presented acutely with DIC and deranged liver function tests. Oesophagectomy 6 months previously for poorly differentiated oesophageal adenocarcinoma. Was receiving adjuvant chemotherapy and immunotherapy.

Specimen:

Liver biopsy (H&E only).

Macroscopic description:
3 tan cores measuring 10, 9 and 8mm.

Immunohistochemistry:
Nil.

Female 59 years

On request form 'intrahepatic cholangiocarcinoma'.

Specimen: Liver resection.

Macroscopic description:
1217g right hemihepatectomy. 103mm pale firm tumour clear of the margin.

Immunohistochemistry:
Cytokeratins 7 and 20 and CDX2 provided.

Male 45 years

Presenting with deranged LFTs. History of significant alcohol excess and anabolic steroid use. Type 1 diabetic.

Specimen:

Liver biopsy (H&E and EPSR).

Macroscopic description:


Liver biopsy.

Immunohistochemistry:
Sirius red.

Male 54 years

Treated as cirrhotic based on Fibroscan (16.1 KPa). Presumed MASLD. Ultrasound showed fatty liver with no evidence of focal lesions but the liver was mildly enlarged. Negative serology. History of asthma, type 2 diabetes, hypertension.

Specimen: biopsy.

Macroscopic description:
2 cores 14 and 12mm.

Immunohistochemistry:
HVG.

Female 66 years

MASLD cirrhosis. Liver transplant today.

Specimen: Liver explant.

Macroscopic description:
Liver explant specimen with nodular appearance. 3mm white lesion noted in segment 2.

Immunohistochemistry:
None.

Female 65 years

Background CLL. Acute hepatitis with jaundice. Hep A-E, CMV, EBV negative. IgG normal. No recent antibiotics/ culprit drugs. Biopsy 'autoimmune hepatitis ? viral ? other.

Specimen: Native liver, needle biopsy.

Macroscopic description:
Core.

Immunohistochemistry:
The lymphoid cells are strongly and diffusely positive for CD20, BCL2, CD5 and CD23, and are negative for cyclinD1, CD10 and BCL6. MUM1 is strongly positive in the proliferation centres. The proliferation fraction on a MIB1 stain is very low < 10%.

Female 42 years

Presented with portal hypertension of unclear cause. Originally from Philippines moved to the UK five years ago. Grew up in a rural village.

Specimen:

Liver biopsy (H/E only).

Macroscopic description:
Liver - multiple cream fragments, the largest measuring 5mm and the smallest 3mm. n[1]nr.

Immunohistochemistry:
None.

Male 75 years

Left hepatectomy for multiple HCCs. Background haemochromatosis.

Specimen: Left hemihepatectomy.

Macroscopic description:
Left hepatectomy specimen containing two lesions measuring 36mm and 70mm respectively.

Immunohistochemistry:
One tumour block, background liver block, VG and Perls stain.

Female 66 years

Recent flu-like symptoms; hepatosplenomegaly; elevated IgG(17.64) and IgM (3.27). ALT 1019; AST 1640; ALK phosphatase 288; GGT 235; AMA-M2 positive; ANA 1:80; Anti-smooth muscle neg; LKM neg sent ? AIH/ PBC/ Lymphoma.

Specimen: Liver core biopsy.

Macroscopic description:
One core liver 17mm length.

Immunohistochemistry:
H&E; retic; PAS; Massons Trichrome.

Male 64 years

Presented with painless jaundice, elevated ALT, ALP, and bilirubin. Viral serology negative. ANA 1/1280, other autoantibodies negative. Normal caeruloplasmin. Normal HFE genotype. Raised IgG. Cirrhotic appearing liver edge on US. At biopsy, ALT 1192, ALP 304, bilirubin 177.

Specimen: Native liver, needle biopsy.

Macroscopic description:
Core.

Immunohistochemistry:
PSR.

Female 64 years

DBD liver transplant with split extended right lobe graft for PSC with recurrent cholangitis. Left lobe and Hilar blocks included (reported at a time when our shikata stain was not working so not able to include).

Specimen: Liver explant.

Macroscopic description:
Liver explant specimen showing scattered distended duct profiles, some of which contain calcified stones. No focal lesions identified. Some narrowing to the common bile duct to the point of bifurcation with dilatation of the right and left hepatic ducts.

Immunohistochemistry:
None.

Male 67 years

Liver and lung lesions identified on imaging studies. The two liver lesions comprise a 4.8cm lobulated partly exophytic lesion in segment III and a further 3cm subcapsular lesion in segment II/IV. Background liver appears cirrhotic on imaging. History of heavy alcohol use. Splenectomy in 1990. Biopsy of left lobe lesion. ? Nature.

Specimen:

Liver biopsy.

Macroscopic description:
Three tan cores 10mm, 7mm and 5mm and one haemorrhagic core 16mm.

Immunohistochemistry:
CD31, ERG, CD68 PG-M1, CD8.