Question

An 81-year-old male with hepatocellular carcinoma was admitted in hospital and complete hepatectomy was performed and unsliced liver was sent to histopathology lab for examination. The sample was well fixed in formalin. Jar containing sample was well labelled along with request form. The sample was rejected by the lab for one reason and sent back to the surgeon. Write in detail that what would be that possible reason due to which that sample was rejected?​

Answer 1

Answer:

An 81-year-old male patient with deteriorating right subcostal pain and high values of serum gamma-glutamyl transpeptidase and alkaline phosphatase underwent an abdominal ultrasound scan, which revealed the presence of a heterogeneous tumor 10cm in diameter, located in the right hepatic lobe, along with mild steatosis of the liver. The patient underwent an abdominal and thoracic computed tomography and an abdominal magnetic resonance imaging. They showed a heterogeneous tumor in the hepatic segment VI, which presented intense arterial uptake of the intravenous contrast followed by quick venous washout, without any sites suspicious for metastases ( Figure 1). Additionally, he underwent an ultrasound-guided biopsy of the mass, which revealed the presence of a moderately differentiated hepatocellular carcinoma (HCC). Serum levels of alpha-fetoprotein (AFP) were within normal range. The patient’s medical history included arterial hypertension, type 2 diabetes mellitus, atrial fibrillation and severe chronic obstructive pulmonary disease (COPD) with chronic productive cough, rendering him a patient with an ASA (American Society of Anesthesiologists) score 3, but no viral hepatitis, cirrhosis or any other liver pathology, apart from mild liver steatosis. Moreover, there was no evidence of renal disease (creatinine serum levels: 0.9 mg/dl, urea serum levels: 25 mg/dl) or anemia (hematocrit: 42.1%, hemoglobin: 14.1 g/dl). The patient’s body mass index (BMI) was 26, he was functionally independent and he was capable of physical activity of light to moderate intensity (Metabolic Equivalent of Task: 3) 3,