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JAMA Surgery Clinical Challenge |

Porta Hepatis Mass QUIZ

Steve M. Niemiec, BA1; Joseph M. Vinetz, MD2; Jason K. Sicklick, MD1
[+] Author Affiliations
1Division of Surgical Oncology, Department of Surgery, Moores UCSD Cancer Center, University of California, San Diego, La Jolla
2Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla
JAMA Surg. 2016;151(2):187-188. doi:10.1001/jamasurg.2015.2425.
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A 64-year-old man from the Philippines presented with 5 months of progressive fatigue, worsening jaundice, and a 13-kg weight loss and no fever, chills, or abdominal pain. What is your diagnosis?

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Figure.

A, Computed tomography of the abdomen demonstrates a 4.4 × 4.3 × 3.5-cm heterogeneous mass in the hepatic hilum (white arrowhead). There is a hepatic stent extending from the right hepatic duct into the second portion of the duodenum. Extensive intrahepatic biliary ductal dilatation is noted. Additional focal peripheral hypodensities (black arrowhead) are visualized in the liver parenchyma. B, Photomicrograph (hematoxylin-eosin, original magnification ×40) demonstrates normal liver parenchyma surrounding multiple caseating granulomas with central necrosis (black arrowheads). Sparse giant cells (white arrowhead) are visualized surrounding the granulomas.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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