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Slide tutorial – case 1

 

68yo male – perihilar liver mass.

Tissue obtained from porta hepatis for frozen section

Review the digital slide here

Microscopic images

Diagnosis:

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

Andrew

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

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