Cholangiocarcinoma: A diagnostic dilemma on cytology

Background

Cholangiocarcinoma is a relatively rare form of adenocarcinoma which may resemble adenocarcinoma of pancreatobiliary origin or adenocarcinomas from many other sites in the body. As a result, its distinction relies mainly on clinical history and morphology.

Case

A 64-year-old male with cirrhosis and worsening liver failure underwent fine needle aspiration of a radiologically detected liver mass. Cytological material showed a monomorphic population of cells arranged in clusters and singly, reminiscent of a neuroendocrine tumor (NET). Cell block morphology added to the diagnostic dilemma by showing a delicate vasculature among the tumor cells. Immunohistochemistry (IHC) on cell block revealed that cells were positive for CK7 and CK19 and negative for synaptophysin and chromogranin, thereby pointing towards pancreatobiliary origin for the tumor and excluding an NET.

Conclusion

In case of liver aspirates, even when encountering confusing morphological entities, it is imperative to keep in mind the possibility of a rare neoplasm like cholangiocarcinoma. In the absence of core needle biopsy, cell block sections prepared from aspirated material can provide appreciable immunohistochemistry results to resolve the diagnostic dilemma.

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