Liver Explants- How to sign them out

(Special thanks to my GI attending, Dr. Jessica Tracht, for these awesome tips)

(Examples/pictures coming soon)

Clinical History & Radiology Findings

These are usually pretty end stage livers and there might not necessarily be great features of the etiology that caused the cirrhosis. Examples of changes include:

-NASH/ASH can burn out and have no fat left

-HCV is usually treated now- fibrosis will regress and there will be little if any inflammation.

  • Clinical history is very important! (labs, serology workup, previous biopsy etc)

  • Always check the radiology reports/imaging to make sure a mass was not seen prior to explant.


What to do if the patient has a history of Hepatocellular Carcinoma

  • Check the radiology report (tumor size, location, vascular invasion, metastases etc)

  • See if they have undergone some type of therapy (TACE, y90, ablation). Saying no neoplastic tissue is important in the diagnosis, because that what the surgeon cares the most about

If the liver is clearly cirrhotic, these need a PAS-D and iron stain.

If the liver is not cirrhotic, these need a PAS-D, iron, and trichrome.


Example Sign Out: Cirrhosis


FINAL DIAGNOSIS:

Liver and gallbladder, native, explant (orthotopic liver transplantation):

  • Cirrhosis with minimal steatosis (<5%), focal ballooning degeneration and scattered Mallory-Denk bodies.

  • No neoplastic tissue is identified.

  • Gallbladder with mild chronic cholecystitis.

  • See comment.


PATHOLOGIST'S COMMENT:

Sections show cirrhotic liver with septal chronic inflammation and bile ductular reaction. There is minimal steatosis (<5%) with focal ballooning degeneration and scattered Mallory-Denk bodies. A special stain for PAS-D shows no PAS positive globules and an iron stain is negative.

The liver is cirrhotic, but the findings are nonspecific as to the etiology. However, the presence of minimal steatosis and occasional ballooned hepatocytes with Mallory-Denk bodies is keeping with burned-out active steatohepatitis due to a toxic/metabolic etiology.

Example Sign Out: Hepatocellular Carcinoma


FINAL DIAGNOSIS:

Liver and gallbladder, native, explant (orthotopic liver transplantation):


Hepatocellular carcinomas x 3, well to moderately differentiated.

  1. 1.2 cm HCC in segment 2/3 with no evidence of therapy effect (100% viable).

  2. 1.0 cm HCC in segment 2 with no evidence of therapy effect (100% viable).

  3. 0.5 cm HCC in left lobe with no evidence of therapy effect (100% viable).

  • No lymphovascular invasion or perineural invasion identified.

  • Two benign lymph nodes (0/2).

  • All margins are negative for carcinoma.

  • Pathologic stage: pT2, pN0.

Additional findings:

  • Cirrhosis with mild septal lymphocytic inflammation and interface activity, consistent with Hepatitis C virus infection.

  • Gallbladder with cholelithalisis, otherwise no specific abnormality.

  • See comment.

Comment: Describe the background liver

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These posts contain high yield information collected from various educational resources including textbooks, journal articles, educational websites and more. They are intended for educational use only and should NOT be taken as medical advice. I strongly believe the spreading of knowledge and depth of learned information should be encouraged in today's society rather than coveted. Membership is required to view these posts  and should be used solely for educational purposes only.