Ashley Stueck, MD, FRCPC

📣 Upcoming Webinar Nov 14!
🔬Immunity and the Liver: A trio of interesting cases 🧐
⭐️ Drs Emily Wilson & Jingmei Lin (Wake Forest), Joshua Wong & Sadhna Dhingra (Houston Methodist), and Julia Gallardo & James Mitchell (UT Southwestern)
📨 Check your email for registration info!
#pathsky #liversky

Promotional card for The Lancet Commission on hepatocellular carcinoma. Background image depicts a computer-generated illustration of a human torso with an inflamed liver.

The global burden of liver cancer is increasing. 📈

Hepatocellular carcinoma (HCC) accounts for approximately 80% of cases globally.

💡 A new Commission outlines evidence-based recommendations for action to reduce the global HCC burden: tinyurl.com/yzxvktkw

#idboardreview 60 F returned from Bolivia, consumed a lot of watercress presents w/ RUQ pain, wt loss, icterus, wbc15k 60%eos, BC neg, LFTs 5x upper limit of normal, normal Alk P, Hepatitis A,B,C negative, CXR neg. StoolO&P negative. dx? #idmedEd #meded #IDsky #idfellows #idfellowship

1/ Bile cast nephropathy is one cause of acute or chronic kidney injury in patients with liver disease (especially obstructive cholestasis). Figure 1 shows two paraffin blocks containing kidney biopsies from two different patients.

#TeachingPoints #kidneypath #renal #pathology

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

Case of the Month: A 67 year old man with a history of chronic obstructive pulmonary disease, prediabetes and abdominal imaging consistent with cirrhosis underwent a non-targeted liver biopsy. What's your diagnosis?

See link in comments for the case!

#Pathology #PathologyOutlines #Diagnosis

🎉 Hot off the press! Our new review on liver resident CD8+ T cells is here - exploring the dual nature of these cells either as protective "Jekyll" 😇 or pathogenic "Hyde” 😈

Dive in to see how the liver microenvironment shapes TRM immunity, pathology & therapeutic potential!

WNT–β-catenin signalling in hepatocellular carcinoma: from bench to clinical trials Nature Reviews Gastroenterology & Hepatology, Published online: 09 October 2025; doi:10.1038/s41575-025-01127-yWNT–β-catenin activation is common in hepatocellular carcinoma (HCC). In this Review, the authors summarize our understanding of the role of WNT–β-catenin activation in HCC — based on results from in vitro and in vivo models — and implications for precision treatment of HCC via targeting β-catenin.

ICYMI: New online! WNT–β-catenin signalling in hepatocellular carcinoma: from bench to clinical trials

Bezafibrate for primary biliary cholangitis: time to act on the evidence Nature Reviews Gastroenterology & Hepatology, Published online: 10 October 2025; doi:10.1038/s41575-025-01135-yAfter the regulatory rejection of obeticholic acid, peroxisome proliferator-activated receptor (PPAR) agonists have emerged as the leading second-line candidates for primary biliary cholangitis, pending definitive approval. Of these, only bezafibrate — a low-cost, widely available generic — has demonstrated long-term efficacy, a fact largely disregarded.

New online! Bezafibrate for primary biliary cholangitis: time to act on the evidence

In Memoriam: Jaume Bosch, MD, PhD Jaume Bosch, a foundational figure in the study of portal hypertension and one of the giants in hepatology, passed away on July 15, 2025, at age 78 years. He leaves behind an immense body of scientifi...

You are unforgettable, and you will always be with us Jaume.

www.gastrojournal.org/article/S001...

There is substantial heterogeneity in the contributors to the pathophysiology of #MASLD, which might influence its rate of progression, its relationship with #cardiometabolic diseases, and the response to therapy www.thelancet.com/journals/lan...
#OpenAccess

#MedSky #EndoSky #LiverSky #HepSky

Ultrasound and MRI images of the liver

Case Record of the MGH: A 59-year-old man with a history of metabolic dysfunction–associated steatotic liver disease had an enlarging liver mass. Biopsy showed hepatocellular carcinoma. Management decisions were made. Read the full case details: nej.md/41Vvxbv

#MedSky #GastroSky

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

Dr Sadnha Dhingra
💊 Immunotherapy may be used as a bridge to transplant for iCCA
🌊Plan for 3 month washout period or increased risk of rejection (T cell- & antibody-mediated)
#USCAP2025 #pathsky #liversky

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)

Dr Vishal Chandan
😲5-10% of HCC can express CDX2
❗️SATB2 can also be seen in HCC: 40-60%!
HCCs with the above usually poorly diff, poor prognosis
🟤5-10% of HCC are K20+
📖Remember that "biliary" keratins, K7 & K19, can also be seen in HCC; the latter can be prognostic
#USCAP2025 #pathsky #liversky

⚪️ 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

@alboothmd.bsky.social
🎨 Pigments which can be seen in the liver: iron, copper, gold, melanin, and silver!
🍴 Silver supplements exist, so do instructions on how to DIY (no medical indication exists); can also be exposed via occupation, topical, or inhalation exposure
#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

Dr Mary Bronner
😱Fulminant necrosis with collapse can mimic cirrhosis
🔬Quality trichrome impt!Necrosis supported by granular necrotic appearance on HE, Kupffer cells (HE, PAS/D), two-toned trichrome (one-toned in F4), reticulin may be hard to interpret
#USCAP2025 #pathsky #liversky

One of my favourite sessions, the #USCAP2025 liver evening subspecialty conference is about to start!
We've got a 🤩💫💯 stacked line-up! #pathsky #liversky

The author's fingernail with two-toned green polish featuring red and gold glitter, matching the USCAP lanyard colours.

The author at the USCAP 2024 meeting, captured looking ridiculously enthusiastic, featuring a bright orange wrist cast, a decision she lived with for 6 weeks and may have regretted....

So last #USCAP2025 I had a broken wrist and intentionally matched my cast colour to the theme colours...
This year I unintentionally (!) did it with my manicure...💅😳

So last #USCAP2025 I had a broken wrist and deliberately matched my cast colour to the theme...
This year, I unintentionally matched my nails....

Dr Ruoyu Shi
🎯Residual viable HCC volume % by pathology is still best way to quantify treatment response
🗣Propose 0% = complete pathologic response, <10% residual tumour = major pathologic response; significantly correlates with OS, RFS
#USCAP2025 #pathsky #liversky