Reproducibility of Histologic Assessment in Porto-sinusoidal Vascular Disease Liver Biopsies

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S156-S157
Author(s):  
M Kmeid ◽  
H Lee ◽  
S M Lagana ◽  
J Lin ◽  
K Affolter ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Vascular Disease ◽  
Interobserver Variability ◽  
Multiple Choice ◽  
Clinical History ◽  
Multiple Choice Questions ◽  
Sinusoidal Dilatation ◽  
History Of ◽  
Liver Biopsies ◽  
Portal Tracts

Abstract Introduction/Objective Variable histologic findings that may be seen in porto-sinusoidal vascular disease (PSVD) liver biopsies are subject to high interobserver variability, requiring correlation with clinical history of portal hypertension (traditionally interpreted as non-cirrhotic portal hypertension NCPH). We investigated which histologic features are reproducible in PSVD biopsies. Methods Archived liver biopsies (n=38) from patients with NCPH (n=14) and without NCPH (n=21) were reviewed. Static H&E images of lobules (L, x100, NCPH=27, non-NCPH=23) and portal tracts (P, x200, NCPH=23, non- NCPH=27) were distributed among 9 gastrointestinal pathologists blinded to clinical history. Each pathologist answered multiple choice questions based on the presence (Q2) or absence (Q1) of portal hypertension clinically. The choice selected by 6 pathologists or more was considered consensus answer for the image. The interpretation of the image was considered reproducible when consensus was reached on both Q1 and Q2. Results The interpretations of 27 (54%; 17L, 10P) images from NCPH and 21 (42%; 10L, 11P) from non-NCPH were reproducible. In NCPH, the interpretations of normal (n=10, 4L, 6P), sinusoidal dilatation (n=7), and increased parenchymal draining vessels (n=3) were reproducible, while there was no consensus on the diagnoses of nodular regeneration and increased number of portal vessels. In non-NCPH, the interpretations of normal (n=8, 2L, 6P), sinusoidal dilatation (n=6), and paraportal shunting vessel(s) (n=4) were reproducible, whereas no consensus was reached on the diagnoses of nodular regeneration, incomplete fibrous septa, and increased number of portal vessels. Conclusion Histologic assessment of normal L and P as well as sinusoidal dilatation appears to be reproducible independent of clinical history. The findings of increased parenchymal draining vessels in NCPH group and paraportal shunting vessels in non-NCPH group may be consistently diagnosed to a certain extent. The assessment for nodular regeneration without reticulin stain, incomplete fibrous septa, or increased number of portal vessels appears to be unreliable.

scholarly journals Interobserver study on histologic features of idiopathic non-cirrhotic portal hypertension

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Michel Kmeid ◽  
Chunlai Zuo ◽  
Stephen M. Lagana ◽  
Won-Tak Choi ◽  
Jingmei Lin ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Interobserver Agreement ◽  
Portal Tract ◽  
Clinical History ◽  
Multiple Choice Questions ◽  
Sinusoidal Dilatation ◽  
History Of ◽  
Group A ◽  
Group B ◽  
Obliterative Portal Venopathy

Abstract Background Histologic features of idiopathic non-cirrhotic portal hypertension (INCPH) may overlap with those without INCPH. Recently, these features have been recognized as part of the larger spectrum of porto-sinusoidal vascular disease (PSVD). We assessed interobserver agreement on histologic features that are commonly associated with INCPH and studied whether a provision of relevant clinical history improves interobserver agreement. Methods The examined histologic features include lobular (such as anisocytosis, nodular regeneration, sinusoidal dilatation, increased parenchymal draining veins, and incomplete fibrous septa) and portal tract changes (such as paraportal shunting vessel(s), portal tract remnant, increased number of portal vessels, and obliterative portal venopathy). Thirty-four archived liver samples from patients with (group A) and without (group B) INCPH were retrieved. A total of 90 representative images of lobules (L) and portal tracts (P) were distributed among 9 liver pathologists blinded to true clinical history. Each pathologist answered multiple choice questions based on the absence (Q1) or presence (Q2) of clinical history of portal hypertension. Fleiss’ kappa coefficient analysis (unweighted) was performed to assess interobserver agreement on normal versus abnormal diagnosis, in L and P, based on Q1 and Q2. Results The kappa values regarding normal versus abnormal diagnosis were 0.24, 0.24, 0.18 and 0.18 for L-Q1, L-Q2, P-Q1, and P-Q2, respectively. With true clinical history provided, the kappa values were L- 0.32, P-0.17 for group A and L-0.12, P-0.14 for group B. Four pathologists changed their assessments based on the provided history. Interobserver agreement on the interpretation of L and P as normal versus abnormal was slight to fair regardless of provision of clinical history. Conclusions Our findings indicate that the histologic features of INCPH/PSVD are not limited to patients with portal hypertension and are subject to significant interobserver variation.

The Utility of Immunohistochemistry in Diagnosing Liver Adenocarcinoma in Patients With Pancreatic Mass

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S142-S142
Author(s):  
Roula Katerji ◽  
Christa Whitney-Miller
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Quality Care ◽  
Previous History ◽  
Clinical History ◽  
Pancreatic Mass ◽  
Specific Marker ◽  
Imaging Studies ◽  
History Of ◽  
Liver Biopsies ◽  
Adenocarcinoma Of The Pancreas

Abstract Objectives Biopsies of liver lesions frequently have two goals: confirm malignancy and determine the site of origin. We frequently encounter liver biopsies in patients with pancreatic mass (PM). Given the lack of a specific marker for pancreatic adenocarcinoma, a broad panel of immunohistochemical (IHC) stains is frequently done. In this study, we evaluated the usefulness of IHC staining in the setting of a liver biopsy in the presence of PM. Methods Between 2011 and 2017, 85 cases of liver biopsies or segmental resections with a diagnosis of adenocarcinoma in the presence of PM were retrieved from our archives. Clinical history of other malignancies, any other lesions detected by imaging studies, CA19-9 levels, and reevaluation of the available H&E and IHC slides were performed. Results The patients were divided into four groups: 74.1% with isolated PM on imaging and no previous history of any malignancy, 12.9% with PM on imaging with previous history-proven adenocarcinoma of the pancreas, 7.0% with PM in association with another lesion shown by imaging studies in other organs, and 5 (5.8%) PM on imaging in association with previous history of cancer somewhere else other than pancreas. At least two IHC stains were performed for each case. CK7 was ordered in all the cases and was positive in 100%; CK20 was positive in 35.8%. Interestingly, TTF-1 was positive in only one case, in the absence of discrete lung mass; the patient was treated for pancreatic adenocarcinoma. Conclusion We suggest that in the presence of PM, with liver metastasis of adenocarcinoma morphology on H&E, the metastasis is from the pancreas or upper gastrointestinal primarily and no need for further stains. Although performing IHC is useful sometimes, it should be ordered wisely; this practice will lower costs and result in higher quality care, with more effective use of the lab resources and personnel.

Porto-Sinusoidal Vascular Disease and Focal Nodular Hyperplasia-like Nodules in a Patient with Neurofibromatosis and Non-Cirrhotic Portal Hypertension

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S124-S125
Author(s):  
A M Alkashash ◽  
S Khan ◽  
R Saxena ◽  
L Nephew ◽  
C Kubal
Keyword(s):  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Vascular Disease ◽  
Focal Nodular Hyperplasia ◽  
Rare Case ◽  
Nodular Hyperplasia ◽  
Synthetic Function ◽  
Portal Veins ◽  
Portal Tracts

Abstract Introduction/Objective Non-cirrhotic portal hypertension (NCPH) is uncommon. The underlying pathophysiology appears to lie at the level of intrahepatic portal veins and sinusoids, hence the term “porto-sinusoidal vascular disease” (PSVD). We report a rare case of PSVD with focal nodular hyperplasia (FNH)-like nodules in a patient with neurofibromatosis type 2 (NF2). Methods/Case Report A 57-year-old male with NF2 and type 2 diabetes, presented with a large variceal bleed requiring blood transfusion and subsequent transjugular intrahepatic portosystemic shunt (TIPS). Imaging showed a nodular liver, presumed to be cirrhosis due to non-alcoholic liver disease. Liver biopsy was not done. Thereafter, he had several episodes of hepatic encephalopathy and TIPS was downsized to prevent recurrences. The patient required liver transplantation for intractable portal hypertension and severe hepatic encephalopathy; his liver synthetic function was near normal and MELD was 11. Portal vein was patent. The explanted liver was micronodular, soft and weighed 946 grams. Unencapsulated nodules, a few mm to 1 cm in size, were present. Microscopically, there was diffuse nodularity in the absence of bridging fibrosis. Thin, incomplete curvilinear fibrous septa were present. There were aberrant veins, hypervascular portal tracts, herniated portal veins and rare occluded portal veins. Trichrome and reticulin stains confirmed architectural abnormalities including nodularity, lack of bridging fibrosis and approximation of portal tracts. Immunohistochemistry for glutamine synthetase accentuated architectural distortion and revealed nodules with FNH-like geographic areas of staining. Results (if a Case Study enter NA) NA Conclusion This is a rare case of NCPH due to PSVD in a patient with NF2. Microscopy suggested incomplete septal cirrhosis (ISC), a pattern associated with both PSVD and regression of fibrosis in a cirrhotic liver. Isolated portal hypertension without loss of synthetic function favors primary PSVD over regression of fibrosis. FNH-like nodules are consistent with regenerative changes caused by localized abnormalities of blood flow.

An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Epigastric Pain ◽  
Umbilical Vein ◽  
History Of ◽  
Clinically Significant ◽  
Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

Fuzzy Evaluation of Examinees Through Multiple Choice Questions

Informatica ◽  
2017 ◽  
Vol 28 (4) ◽  
pp. 609-628
Author(s):  
Ali Fahmi ◽  
Cengiz Kahraman
Keyword(s):  
Multiple Choice ◽  
Fuzzy Evaluation ◽  
Multiple Choice Questions

Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

2020 ◽  
Vol 41 (5) ◽  
pp. 336-340
Author(s):  
Yasmin Hamzavi Abedi ◽  
Cristina P. Sison ◽  
Punita Ponda
Keyword(s):  
Retrospective Chart Review ◽  
Clinical History ◽  
Specific Ige ◽  
Exact Test ◽  
Ara H 1 ◽  
Sige Level ◽  
History Of ◽  
Laboratory Procedures ◽  
Ige Mediated ◽  
The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

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