Case history

A patient presents with extrahepatic cholangiocarcinoma, a biopsy of the liver shows the following:

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What stain is most likely to be the most helpful to make the diagnosis?

  1.       Ki-67 
  2.       CK7
  3.       Arginase
  4.       No additional stains needed

Answer: D, No additional stains needed.

Discussion

The liver sections here show extensive fibrosis, portal edema, bile ductular proliferation, and reactive epithelial changes.  This is all occurring in a primarily periportal distribution.  This pattern can be seen in severe biliary obstruction and is benign.  However, the pattern of bile duct proliferation in this case is secondary to distal obstruction of extrahepatic cholangiocarcinoma.  To be more precise, this patient had a Klatskin tumor.  A Klatskin tumor is just the name given for a cholangiocarcinoma which occurs at the specific anatomic location of the confluence of the left and right hepatic bile ducts.  
 

Case contributed by Robin Collingwood, M.D., GI Pathology Fellow, UAB Department of Pathology