PMC4939185_01
(a) Patient's primary rectosigmoid adenocarcinoma. (b) Liver resection for CRC metastasis four years ago. (c) Biopsy of intrabiliary mass. ((d) and (e)) Resection of the intrabiliary metastasis. (f) Smaller liver nodular lesions. All images are H & E (x40).
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His past history was significant for rectosigmoid adenocarcinoma (pT1N0) resection ten years ago (Figure 1(a)). He also had liver resection for colorectal cancer metastasis four years ago (Figure 1(b)) and history of melanoma with resection a year ago. The pathologic evaluation of biopsy from the bile duct stricture was significant for adenocarcinoma (Figure 1(c)). Intrabiliary tumor showed papillary architectures with colonization of bile ducts (Figures 1(d) and 1(e)). Smaller satellite nodules in liver showed typical metastatic colon carcinoma like morphology (Figure 1(f)).
MRI showing the intrahepatic lesion.
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Further evaluation by the MRI study showed a 1.4 x 1.1 cm intraductal mass consistent with primary cholangiocarcinoma at hepatic hilum with severe bilobar intrahepatic ductal dilation (Figure 2).
The intrabiliary tumor is positive for CDX2 staining (a and c) and negative for CK7 staining (b and d). CK 7 highlights background bile duct epithelium (b and d). (a and b): x40; (c and d): x200.
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However, IHC staining of both intrabiliary and smaller hepatic nodules demonstrated same pattern with positive CDX2 expression and CK20 expression and negative for CK7 (Figure 3).