An interesting case of intrahepatic cholangiocarcinoma

Introduction Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver malignancy. It is classifiable into mass forming, periductal infiltrating and intraductal growth types grossly. Recognition of these patterns is important as they can be related to different prognosis. Until recently, the staging system for hepatocellular carcinomas was also applied to these tumours, however, important changes have been made on the basis of retrospective analysis of data in a multi-institutional analysis, and a new separate staging system for ICC has been introduced in the 7 th edition of AJCC classification and staging. Case report An 83-year-old man who presented with malaise, weight loss and abnormal liver test, was found to have an ill-defined mass in his liver by imaging. Excisional biopsy showed a stellate pink solid mass 47 mm in maximum dimension with some infiltrative linear thickening at the periphery. Microscopically, the lesion was confirmed to be a moderate to poorly differentiated ICC with mixed mass forming and periductal pattern. Foci of vascular and perineural invasion were noted. The tumour was staged pT4 in view of the periductal pattern. Conclusion According to the 7th edition of TNM staging, having features of periductal pattern takes the tumour into stage pT4. In contrast to hepatocellular carcinoma staging, size is not considered relevant for prognostication and has therefore been excluded from staging criteria of ICC in the recent AJCC classification, 7th edition.