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<p class="ql-align-justify">Sections from the liver biopsy show two tiny tissue fragments focally involved by an atypical epithelial proliferation arranged in sheets with focal attempts at glandular differentiation, composed of an intimate mixture of large polygonal epithelioid cells and elongated spindle-shaped cells exhibiting severe nuclear atypia, with active mitosis, within a desmoplastic stroma. The remaining separate fragments show preserved to mildly altered liver architecture with expanded portal tracts linked by thin bands of dense fibrous bridging septa. These septa contain a prominent lymphocytic and histiocytic inflammatory infiltrate with active interface hepatitis extending across the limiting plate. Hepatocytes display marked, widespread macrovesicular steatosis, focal ballooning degeneration, scattered apoptotic hepatocytes, and focal reactive bile ductular proliferation at the septal margins, without well-formed regenerative nodules or established cirrhosis.</p>
<p class="ql-align-justify">Acute calcular cholecystitis underwent liver biopsy to exclude metastasis, given past medical history of operated left breast cancer.</p>
<p class="ql-align-justify">Soft tissue fragments collectively measured 1.3x1x0.6 cm, totally embedded.</p>
<p><strong><em><u>Liver, Core Biopsy: </u></em></strong></p><ul><li><strong>Crushed atypical epithelioid cells with focal glandular differentiation, suspicious for metastatic adenocarcinoma from previously diagnosed breast primary (High-Grade).</strong></li><li><strong>Background liver shows chronic hepatitis with significant fibrosis (METAVIR Grade A2, Stage F2) and marked macrovesicular steatosis.</strong></li></ul><p><br></p><p><strong>Immunohistochemical Recommendations: </strong></p><p class="ql-align-justify">An immunohistochemical panel is recommended to confirm metastatic adenocarcinoma (consistent with a breast primary) and exclude primary hepatocellular carcinoma. The suggested confirmatory markers include: <strong>GATA3, Glypican-3, ER, PR, HER2, CK7, CK20, and Arginase-1 or HepPar-1.</strong></p>
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