Blog
Slide tutorial – case 1
68yo male – perihilar liver mass.
Tissue obtained from porta hepatis for frozen section
Review the digital slide here
Microscopic images
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- Slide overview
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- Low power view of inflammatory area
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- High power of inflammatory areas
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- Low power view of embedded CBD
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- High power of embedded CBD
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- Low power view of involved nerve branches
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- Epithelial elements within nerve branches
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- Invasive carcinoma in large nerve branches
Diagnosis:
Video tutorial
[youtube]http://youtu.be/GjWhQmHuT7Y[/youtube]
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
