Grypari Ioanna Maria, Vlachos Iakovos, Stoupi Eleni, Karandrea Despoina, Myoteri Despoina, Tiniakos Dina
Department of Pathology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vas. Sofias Avenue, Αthens, 11528, Greece.
Department of Pathology, General Hospital of Athens Ippokrateion, Athens, Greece.
Virchows Arch. 2025 Aug 13. doi: 10.1007/s00428-025-04215-1.
Difficult liver pathology cases often require expert review for optimal patient care. We reviewed consult cases received in our reference centre aiming to highlight challenging areas in hepatopathology that may benefit from specialist consultation and focused educational activities. We included all primary liver consult cases received between 10/2016 and 12/2022. Data on the sender and aetiology for consultation were collected. Initial and consult reports were screened for adequacy of clinical information, stains performed, final diagnosis and disease grading/staging. We retrieved 219 liver consults, 187 submitted by hepatologists. For medical cases, most common initial diagnoses were non-specific changes, chronic hepatitis and cirrhosis without underlying aetiology. Most common consult diagnoses were vascular disease, primary biliary cholangitis and metabolic dysfunction-associated steatohepatitis (p < 0.001). Major change in initial diagnosis was noted in 72 (49%), minor change in 38 (25.9%) and no change in 23 (15.6%) cases. For focal liver lesions (n = 72), most common initial diagnoses were hepatocellular carcinoma (HCC), non-specific or metastatic. Most common consult diagnoses were HCC, cholangiocarcinoma or non-neoplastic liver (p = 0.033). Major change in initial diagnosis was noted in 30 (41.7%), minor change in 24 (33.3%) and no change in 15 (20.8%) cases. Study of liver consult patterns provides useful information on areas of hepatopathology posing diagnostic difficulty. Most challenging fields are vascular liver disease, interpretation of hepatitic pattern, primary cholangiopathy and classification and subtyping of hepatocellular tumours. These areas can be the subject for future medical educational activities in hepatopathology.
复杂的肝脏病理病例通常需要专家会诊以实现最佳的患者护理。我们回顾了在我们参考中心收到的会诊病例，旨在突出肝脏病理学中可能受益于专家会诊和针对性教育活动的具有挑战性的领域。我们纳入了2016年10月至2022年12月期间收到的所有原发性肝脏会诊病例。收集了关于发送者和会诊病因的数据。对初始报告和会诊报告进行筛选，以检查临床信息的充分性、所进行的染色、最终诊断以及疾病分级/分期。我们检索到219例肝脏会诊病例，其中187例由肝病学家提交。对于内科病例，最常见的初始诊断是非特异性改变、慢性肝炎和无潜在病因的肝硬化。最常见的会诊诊断是血管疾病、原发性胆汁性胆管炎和代谢功能障碍相关脂肪性肝炎（p＜0.001）。72例（49%）病例的初始诊断有重大改变，38例（25.9%）有轻微改变，23例（15.6%）无改变。对于局灶性肝病变（n = 72），最常见的初始诊断是肝细胞癌（HCC）、非特异性或转移性病变。最常见的会诊诊断是HCC、胆管癌或非肿瘤性肝脏（p = 0.033）。30例（41.7%）病例的初始诊断有重大改变，24例（33.3%）有轻微改变，15例（20.8%）无改变。对肝脏会诊模式的研究为肝脏病理学中造成诊断困难的领域提供了有用信息。最具挑战性的领域是肝脏血管疾病、肝炎模式的解读、原发性胆管病以及肝细胞肿瘤的分类和亚型划分。这些领域可以成为未来肝脏病理学医学教育活动的主题。
