Qap (Anatomical Pathology) 

QAP Peer Review

AP144
Case History: M/68 3 cm nodule in segment 3 of liver. Segmentectomy done.
Intended diagnosis: Well differentiated hepatocellular carcinoma arising in a high-grade dysplastic nodule in a background of cirrhosis. Contributed by:MST
Code Diagnosis Comment Score
anonymous Hepatocellular carcinoma in cirrhotic liver (100%) Suggest reticulin stain for demonstration of thickened liver cell plates and decreased reticulin fibres. A number of Mallory bodies are found in the non-neoplastic liver cells, together with focal steatosis and nuclear vacuolation. Please check underlying cause of cirrhosis including Wilson’s disease and alcoholic liver disease.  98
anonymous Hepatocellular carcinoma in a cirrhotic liver (100%) nil  98
anonymous Well-differentiated hepatocellular carcinoma; cirrhosis. 100% nil  98
anonymous Hepatocellular carcinoma nil  90
anonymous Well-differentiated hepatocellular carcinoma, grade 2 out of 4, arising from a background of cirrhosis, grade 2 activity. 100% At the periphery of the tumor, there are features of dysplastic nodule.  100
anonymous Focal nodular hyperplasia. (100%) nil  0
anonymous Liver - Well differentiated hepatocellular carcinoma, in a background of active macronodular cirrhosis (100%) nil  98
anonymous Well differentiated hepatocellular carcinoma (70%) vs dysplastic nodule (30%); with a background of cirrhosis. Need to perform reticulin stain to look for lost of reticulin framework and thickened trabecular pattern. Hepatocellular carcinoma shows extensive loss of reticulin and frequent thick cell plates (> 3 cells). Dysplastic nodule shows focal loss of reticulin. Thick cell plates are less frequently found.  90
anonymous Well Differentiated hepatocellular carcinoma 70% Focal nodular hyperplasia 30% Suggest further sampling to assess presence of nuclear pleomorphism and architectural abnormality.  65
anonymous Well-differentiated Hepatocellular Carcinoma in a background of cirrhosis (100%) As adjacent tissue shows relatively dense mononuclear infiltrate of septa and portal tracts, suggest correlation with serologic markers (HBsAg & anti-HCV antibody) to determine etiology of tumor and cirrhosis. Suggest reticulin stain to search for presence of pre-existing dysplastic nodule from which the hepatocellular carcinoma arises.  99
anonymous Well-differentiated hepatocellular carcinoma in a background of cirrhosis (100%) nil  98
anonymous Hepatocellular carcinoma in cirrhotic liver. Probability: 100% nil  98
anonymous Well differentiated hepatocellular carcinoma (100%); cirrhosis. The uninvolved liver shows cirrhosis containing also Mallory hyaline bodies; correlation with clinical and serological findings is suggested for possible association with alcoholism or HBV infection.  98
anonymous focal nodular hyperplasia would do reticulin stain, pCEA , CD34 to exclude a well differentiated hepatocellular carcinoma.  15
anonymous hepatocellular carcinoma nil  90