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Liver and intrahepatic bile ducts - tumor

Hepatocellular carcinoma


Reviewers: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 January 2013, last major update February 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.


● 90% sensitive and specific for hepatocellular carcinoma
● Cell blocks helpful for obtaining stains (reticulin stain shows no framework)
● False positives due to regenerative nodules
● False negatives in well-differentiated tumors
● Complications: tumor may track along needle path (Korean J Hepatol 2011;17:106)

Cytology description

● Gross inspection of the hypercellular smears reveals trails of particulate tissue imparting a granular pattern of spread
● Granules consist of cohesive clusters of malignant hepatocytes with arborizing, tongue-like projections of broad cords wrapped by peripheral endothelium
● Rows of transgressing endothelium are accompanied by basement membrane material, resembling pink "tram-lines"
● Polygonal tumor cells with abundant eosinophilic cytoplasm, central hyperchromatic nuclei or variable prominent nucleoli, malignant cells separated by sinusoidal epithelial cells, increased nuclear to cytoplasmic ratio, trabecular pattern and atypical naked nuclei
● Increased nuclear to cytoplasmic ratio; often naked tumor cell nuclei
● Aggregates may appear trabecular (branching sinusoids lined by elongated epithelial cells with adjacent polygonal tumor cells or polygonal tumor cells with adjacent endothelial cells)
● Variable rosettes or acini (pseudoglandular pattern), tumor giant cells, malignant spindle cells; also variable bile, hyaline globules, Mallory’s hyaline and cytoplasmic vacuoles

Cytology images

Left to right: well, moderately and poorly differentiated HCC

Various images

Breast mass representing metastatic disease

Differential diagnosis

● Reactive hepatocytes: finely granular chromatin, cells maintain cohesion (Arch Pathol Lab Med 2002;126:670)
Focal nodular hyperplasia
Hepatic adenoma

End of Liver and intrahepatic bile ducts - tumor > Hepatocellular carcinoma > Cytology

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