Liver and intrahepatic bile ducts - tumor
Hepatocellular carcinoma

Author: Deepali Jain, M.D. (see Authors page)

Revised: 22 November 2017, last major update February 2012

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Hepatocellular carcinoma[TI] cytology[TI]

Cite this page: Jain, D. Cytology. website. Accessed October 15th, 2018.
Definition / general
  • 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 hyaline and cytoplasmic vacuoles
Cytology images

Images hosted on other servers:

Various images

Breast mass representing metastatic disease

Differential diagnosis