For a detailed review, see "How Molecular Discoveries Have Changed Liver Tumor Pathology: A Brief Review" at https://meridian.allenpress.com/aplm/article/148/5/e96/495433

Found IVC abnormalities and tear during procurement explaining the course mimicking hyperacute rejection

🔬Hyperacute rejection expect sinusoidal congestion, hepatic vein congestion, platelet aggregates and fibrin thrombi, erythrophagocytosis, necrosis
🩸This case: z3 congestion, some platelet aggregates
🟢On IF, found C1Q; no C4d
⛔️No DSA

🔷️ A patient with iCCA underwent OLT 1 month after stopping immunotherapy; the liver (ABO compatible) allograft turned blue during perfusion - 😱 Graft removed, plasma exchange and steroids given, 2nd OLT successful

Remember to use a PANEL!

🟫Arginase & HSA can be negative in HCC, even grade 1, and occasionally + in other tumours (including hepatoid adenoca); also, beware entrapped non-neoplastic hepatocytes
🟤Glypican-3 helpful in malig vs not, not so much HCC vs not; can stain lipofuscin (pitfall)

⚪️ silver (argyria) in liver- Granular pigment in macrophages, can accumulate to extent it causes liver injury and fibrosis; negative on Fe, rhodanine, Schmorl stains
💊 Be aware of homeopathic remedies!
#USCAP2025 #pathsky #liversky

👩🏽‍⚕️Communication with hepatologists and history is essential!
🗝Detailed presentation history, past history of liver disease, meds/toxins
🩻 imaging signs of portal hypertension rare in acute fulminant injury
#USCAP2025 #pathsky #liversky