Slide tutorial – case 1


68yo male – perihilar liver mass.

Tissue obtained from porta hepatis for frozen section

Review the digital slide here

Microscopic images


Spoiler Inside SelectShow

Video tutorial


Case discussion

This is an important case because it is subtle and can be missed, particularly in the setting of a frozen section.

The key features to take away include;

  • The presence of malignant glands within large nerve branches, consistent with metastatic cholangiocarcinoma
  • The presence of ‘decoy’ xanthogranulomatous inflammation – this could explain the clinical mass lesion but shouldn’t make you stop looking
  • Cholangiocarcinoma can look architecturally and morphologically bland – keep this in mind when performing frozen sections from this area.

Extended learning topics

DDx for lesions at the porta hepatis
DDx for well differentiated bile duct lesions/proliferations
Role of IHC in cholangiocarcinoma


Drop me a line of call me at Tissupath if you would like to discuss any of these cases further


The case has been de-identified and is intended for educational purposes only

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