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Presented by Pedram Argani, M.D. and prepared by Marc Halushka M.D., Ph.D.
Case 4: 82 year-old male with a liver nodule discovered upon laparoscopy for a pancreatic adenocarcinoma.
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1. Question
Week 181: Case 4
82 year-old male with a liver nodule discovered upon laparoscopy for a pancreatic adenocarcinoma.images/Halushka/conf51804/case4image1.jpg
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images/Halushka/conf51804/case4image4.jpgCorrect
Answer: Bile duct adenoma
Histology: The lesion is composed of proliferated ductules in a somewhat fibrotic stroma. Centrally, the ductules have an elongated architecture. While intracytoplasmic mucin is evident, and there is mild atypia, mitoses are not seen.
Discussion: Von Meyenberg complexes usually have a staghorn appearance and contain intraluminal bile. Metastatic carcinoma should show more advanced cytologic atypia, and mitotic activity, both of which are absent from the current lesion. Reactive bile duct proliferations are typically associated with an edematous stroma and bile plugs, neither of which was present in the current specimen.
Incorrect
Answer: Bile duct adenoma
Histology: The lesion is composed of proliferated ductules in a somewhat fibrotic stroma. Centrally, the ductules have an elongated architecture. While intracytoplasmic mucin is evident, and there is mild atypia, mitoses are not seen.
Discussion: Von Meyenberg complexes usually have a staghorn appearance and contain intraluminal bile. Metastatic carcinoma should show more advanced cytologic atypia, and mitotic activity, both of which are absent from the current lesion. Reactive bile duct proliferations are typically associated with an edematous stroma and bile plugs, neither of which was present in the current specimen.
