Histopathology Report

• tumour type - hepatocellular carcinoma/cholangiocarcinoma/metastatic carcinoma.

• tumour differentiation - well/moderate/poor.

• extent of local tumour spread (hepatocellular and intrahepatic cholangiocarcinoma)

Posterior

Posterior

Parahilar longitudinal plane of section

Figure 9.4. Total hepatectomy specimen.

Parahilar longitudinal plane of section

Sample transverse sections of the porta hepatis and represent any mass lesion in relation to the capsule, porta hepatis and other structures e.g veins. Sample nonlesional liver of each lobe.

Figure 9.4. Total hepatectomy specimen.

- pT1 solitary tumour without vascular invasion.

- pT2 solitary tumour with vascular invasion or multiple tumours, none more than

5 cm in greatest dimension.

- pT3 multiple tumours more than 5 cm or tumour involving a major branch of the portal or hepatic vein.

- pT4 tumour(s) with direct invasion of adjacent organs other than the gall bladder or with perforation of visceral peritoneum.

• lymphovascular invasion - present/not present. Note the propensity for hepatocellular carcinoma to invade portal tract veins, major branches of portal and hepatic veins and inferior vena cava. Cholangiocarcinoma typically shows perineural space invasion with spread to lymph nodes, lungs and peritoneum.

• regional lymph nodes: hilar (hepatoduodenal ligament), hepatic (along the proper hepatic artery), periportal (along the portal vein) and those along the abdominal inferior vena cava above the renal veins (except the inferior phrenic nodes).

- pN0 no regional lymph node metastasis.

- pN1 metastasis in regional lymph node(s).

• excision margins:

- distances (mm) to the capsule and limits of excision of the hepatic parenchyma, bile ducts and major veins.

• other pathology:

- hepatocellular carcinoma

- hepatitis, cirrhosis (hepatitis/alcohol/haemochromatosis, etc.), adenomatous hyperplastic nodules, liver cell dysplasia.

- cholangiocarcinoma

- primary sclerosing cholangitis, ulcerative colitis, liver fluke, biliary tree anomaly.

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