Total Hepatectomy: Cirrhosis
The specimen is received in formalin labeled “patient liver” and consists of a 1250 g, 23.2 x 20.3 x 7.5 cm liver. The capsule is pink-yellow, diffusely hemorrhagic, and diffusely nodular. The porta hepatis is identified and the portal vein appears to be obstructed by a white amorphous substance occupying approximately 10-15% of the lumen..A possible hilar lymph node is identified which measures 1.0 x 0.6 x 0.5 cm.
Sectioning along a modified axial plane reveals a tan-yellow, diffusely cirrhotic, and diffusely nodular cut surface. In addition, diffuse trabeculations of pink-gray necrosis occupy approximately 45-55% of the parenchyma.
Attached to the liver is a dilated gallbladder which measures 7.5 cm in length and 3.0 cm in greatest diameter. The serosa is pink-tan, smooth, focally hemorrhagic, and congested. The lumen contains approximately 5-10 cc of green-tan, hemorrhagic, viscous bile admixed with at least 10 firm yellow-green variegated multifaceted stones ranging from 0.2 -2.0 cm in greatest dimension. The mucosa is green-tan, velvety, and coarsely trabeculated. The wall measures 0.5 cm in maximum thickness.
Representative sections are submitted in cassettes A1-A5:
- A1: Hilar margin
- A2: 1 lymph node, bisected
- A3: Right lobe, 4 rep. sections
- A4: Left lobe, 4 rep. sections
- A5: Gallbladder
Partial Hepatectomy: Hemangioma
The specimen is received fresh for frozen section analysis labeled “right hepatic lobe + gallbladder” and consists of an oriented, 665 g, 18.5 x 16.0 x 4.5 cm, partial hepatectomy specimen. The capsular surface is red-brown, smooth, and unremarkable. There is one long blue stitch designating the superior margin and 2 short sutures designating the anterior margin. The posterior-inferior margin is inked in black. The posterior-superior margin is inked in blue.
The specimen is serially sectioned from superior to inferior to reveal a 3.9 x 3.5 x 2.5 cm, well circumscribed, hemorrhagic, friable mass. The lesion is located 0.3 cm from the posterior-inferior margin and 4.5 cm from the posterior–superior margin. The remainder of the liver parenchyma is red-brown, soft, and lacks any grossly discrete lesions, hemorrhage, or necrosis.
The attached dilated gallbladder measures 8.8 cm in length and 2.6 cm in greatest diameter. The serosa is green tan, smooth and congested. The lumen contains approximately 20 cc of yellow-tan bile and no calculi. The mucosa is green-tan, velvety, and unremarkable. The wall measures 0.3 cm in maximum thickness.
Representative sections are submitted in cassettes A1-A7:
- A1: Frozen section control block
- A2-A3: Tumor and nearest margin
- A4-A5: Tumor, including adjacent uninvolved parenchyma
- A6: Uninvolved parenchyma
- A7: Gallbladder
ALINA MAYSTERCHUK 