Female 63 years

Progressive hepatitis ? cause.

Core biopsy right liver lobe. Extracted from clinical letter: 1. RTEL1 mutation with telomerase shortening 2. Familial pulmonary fibrosis related to the above 3. Hypogammaglobulinemia with IVIG infusions and replacement 4. Seronegative rheumatoid arthritis 5. Evolving pulmonary and hepatic fibrosis 6. Previous liver biopsy with indeterminate changes 7. Probable micro-vascular disorder of the liver (NCPH-type disease).

Specimen: Liver core.

Macroscopic description:
Two cores 3-13mm.

Immunohistochemistry:
PASD, reticulin, van Gieson, Sirius Red, Orcein.

Female 55 years

Admitted jaundiced on a background of a few months of fatigue. Transaminitis on bloods. Negative A-E serology. IgG 15.6. [LFTs at biopsy - ALT 840, bilirubin 376, ALP 207. ANA 1/80; other autoantibodies negative] Provisional diagnosis: Autoimmune hepatitis.

Specimen: Native liver, needle biopsy.

Macroscopic description:
Core.

Immunohistochemistry:
NA.

Male 59 years

Patient undergoing a combined liver and kidney transplant. One representative section of his liver provided - which is reflective of the liver as a whole.

Specimen: Section from recipient's original liver (liver explant).

Macroscopic description:
Enlarged liver.

Immunohistochemistry:
None.

Female 39 years

Incidental segment IVb liver lesion on CT for kidney stone investigation. Initially thought to be FNH, may be adenoma.

Specimen: Native liver, targeted needle biopsy.

Macroscopic description:
Core.

Immunohistochemistry:
There is diffuse hepatocellular immunopositivity for serum amyloid A and glutamine synthetase, although there is no non-lesional tissue for comparison. Normal LFABP immunopositivity is retained. There is extensive but patchy capillarisation (CD34). No nuclear Beta catenin immunopositivity.

Male 56 years

No clinical information provided. Further information from EPR: Amyopathic dermatomyositis (on Privigen infusions, hydroxychloroquine, tacrolimus, prednisolone, sildenafil, nifedipine, iloprost). Longstanding deranged LFTs. BMI 23. LFTs ALT 78, AlkPhos 188, Bili 14, Alb 32. US abdomen - Left lobe of liver appears slightly enlarged with a slightly nodular outline and heterogenous echotexture suggestive of fibrotic change. Fibroscan 14.6 kPa.

Specimen: Medical liver biopsy.

Macroscopic description:
One core of tissue measuring 24mm in length.

Immunohistochemistry:
Retic, VG and CK7.

Female 60 years

Resection of a 50mm liver cyst.

Specimen: Liver resection.

Macroscopic description:
Liver resection containing a 50 x 35 x 44mm cystic lesion.

Immunohistochemistry:
None.

Female 66 years

On Imuran for long term colitis; MRCP no features of PSC; IgG IgM normal; rapidly rising bilirubin; had treatment 2 weeks previously (2 doses) Augmentin; ANA 1:80;

Specimen: Liver core biopsy.

Macroscopic description:
1 x liver core biopsy 18mm length.

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

Male 66 years

Liver resection for a hepatocellular carcinoma (imaging diagnosis). This is a section from the background liver.

Specimen: Liver resection.

Macroscopic description:
Liver resection containing a 47mm lesion. The background liver was noted to show cystic changes associated with large septal tracts and a nodular appearance.

Immunohistochemistry:
H&E and EPSR provided.

Female 54 years

Decompensated cirrhosis; history diabetes; viral screen neg; auto antibodies neg; GGT 121; ALT normal; elevated total bilirubin (69); no other history available.

Specimen: Liver core biopsy transjugular.

Macroscopic description:
3 cores of liver 5mm 7mm 9mm.

Immunohistochemistry:
H&E; retic, PAS.

Male 77 years

Bladder G3 T3 TCC. New liver lesion.

Specimen:

Liver biopsy.

Macroscopic description:
Two cores of tissue measuring up to 16mm plus two smaller fragments.

Immunohistochemistry:
None.

Male 61 years

Resection of a liver mass. Type 2 diabetes mellitus, hypertension.

Specimen: Liver resection.

Macroscopic description:
Liver resection containing a 16mm lobulated tan-green lesion.

Immunohistochemistry:
Glutamine synthetase, glypican-3, HepPar1, HSP70 and EPSR.

Male 63 years

Persistent rising liver chemistry after vismodegib (kinase inhibitor in hedgehog pathway). Undefined situation.

Specimen:

Liver biopsy.

Macroscopic description:
liver core 25mm.

Immunohistochemistry:
H&E and EPSR.

Male 10 years

Acute seronegative hepatitis ??autoimmune disease.

Specimen: Biopsy.

Macroscopic description:
Cores 1.5 and 0.5cm.

Immunohistochemistry:
Orcein.