Qap (Anatomical Pathology) 

QAP Peer Review

AP140
Case History: F/46, history of repeated episodes of jaundice and fever. Left lateral segmentectomy.
Intended diagnosis: Recurrent pyogenic cholangitis. Contributed by:IOLN
Code Diagnosis Comment Score
anonymous Liver - changes of sclerosing cholangitis (100%) Please consider sclerosing cholangitis, primary or secondary. The history of jaundice, fever and segmentectomy raises the possibility of recurrent pyogenic cholangitis. Please correlate with clinical findings, radiological results, operative findings and changes in other histological sections.  100
anonymous Benign liver nodule (100%), favour focal nodular hyperplasia nil  0
anonymous Consistent with recurrent pyogenic cholangitis. (100%) The slide shows fibrosis, paucity of bile ducts, as well as periductal fibrosis. Such findings, together with the clinical history, make recurrent pyogenic cholangitis the most likely conslusion.  100
anonymous Vanishing bile duct syndrome (100%) correlate with clinical features/ serology of sclerosing cholangitis, recurrent pyogenic cholangitis, transplant rejection etc.  80
anonymous Secondary sclerosing cholangitis due to recurrent pyogenic cholangitis. 100% nil  100
anonymous Absence of large bile duct with fibrosis around large vessels, the features are in keeping with late stage of recurrent pyogenic cholangitis. (100%) Suggest clinical-radiological-endoscopic correlation.  100
anonymous Morphologic description: Absent large bile ducts and prominent fibrosis in large portal areas. 100% History suggested lady suffered from recurrent pyogenic cholangitis. There are no active or acute cholangitic features in this section. It could be end-stage, secondary sclerosing cholangitis.  100
anonymous Recurrent pyogenic cholangitis (60%) Focal nodular hyperplasia (30%) Primary sclerosing cholangitis, segmental form (10%). Correlate with clinical history, radiological and cholangiogram findings if available. A space occupying lesion favours focal nodular hyperplasia over recurrent pyogenic cholangitis.  100
anonymous Primary Biliary Cirrhosis 100% nil  30
anonymous SCLEROSING CHOLANGITIS with loss of interlobular bile ducts 100% Differential diagnoses include primary and acquired sclerosing cholangitis and recurrent pyogenic cholangitis. Suggest correlation with clinical and radiological findings.  100
anonymous Vanishing bile duct syndrome (100%) Section shows paucity of intrahepatic bile ducts including absence of large segmental ducts. The corresponding large arteries show marked intimal proliferation close to endarteritis obliterans. Possible aetiologico-pathogenetic mechanisms: (1) Syndromic: intrahepatic biliary atresia, as suggested by absence of significant inflammation; but uncommon in this age group (usually in children) (2) Non-syndromic: Sclerosing cholangitis - (a) immune mechanism: primary sclerosing cholangitis, autoimmune cholangitis; (b) ischemia; (C) infection: viral (EBV),etc; (d) toxic: drug-induced; (e) miscellaneous  50
anonymous Focal nodular hyperplasia 100% nil  0
anonymous DDx: Recurrent pyogenic cholangitis, primary sclerosing cholangitis, hepatic adenoma. Probability: 100% Correlate with radiological findings.  80
anonymous Focal nodular hyperplasia Nil  0
anonymous Focal nodular hyperplasia nil  0