October 2019 — Gastrointestinal

A 64-year-old man was found to have an incidental liver mass on ultrasonography during a work-up for chronic kidney disease. He had a history of alcohol use, which he discontinued in 2011. On further evaluation, his liver function tests (ALT, AST, total bilirubin, and alkaline phosphatase) were within normal limit. Tests for hepatitis B and C viral infection were negative. CA 19-9, CEA, and alpha-fetoprotein were all within the normal reference range. On imaging, there was an indeterminate mass in the posterolateral right hepatic dome, measuring approximately 6.3 x 5.6 cm. We received a liver V and VIII segmentectomy, showing a single 5.9 x 5.5 x 4.6 cm red-yellow, friable, encapsulated mass, which was present at 0.5 cm form the inked margin.

Section of liver mass with fibrous capsule and adjacent liver parenchyma (H&E, 2x)
Liver mass with fibrous capsule (H&E, 2x)
Tumor cells associated with intra-tumoral and peri-tumoral lymphocytes (H&E, 40x)
Mucin stain
Markers of hepatic differentiation
Albumin by ISH (in-situ hybridization)
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Aqsa Nasir, M.B.B.S.
Fellow, Surgical Pathology
Mayo Clinic
Saba Yasir, M.B.B.S.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

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