Liver and intrahepatic bile ducts - tumor
Hepatocellular carcinoma
Scirrhous type


Topic Completed: 8 April 2019

Revised: 10 April 2019

Copyright: 2002-2019, PathologyOutlines.com, Inc.

PubMed Search: Scirrhous hepatocellular carcinoma[TIAB]
Page views in 2018: 1,273
Page views in 2019 to date: 481
Cite this page: Fels Elliott DR, Gill RM. Scirrhous type of hepatocellular carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/livertumorsclerosingHCC.html. Accessed April 19th, 2019.
Definition / general
Essential features
  • Unencapsulated, often subcapsular location, may have satellite lesions
  • Abundant fibrous stroma but lacks central scar or radiating fibrous bands
  • No criteria defining the amount of fibrous stroma required for the diagnosis
Terminology
  • Also called sclerosing variant of HCC
ICD coding
  • ICD-10: C22.7 - Other specified carcinomas of liver
Epidemiology
Clinical features
Radiology description
  • Radiographic appearance may be similar to cholangiocarcinoma
  • Contrast enhanced CT scan shows peripheral ring enhancement in arterial phase and delayed central enhancement in venous phase (Eur J Radiol 2009;69:123)
Radiology images

Images hosted on other servers:

CT scans with scirrhous HCC

Prognostic factors
Case reports
Treatment
Gross description
  • Unencapsulated, gray-white, firm, lobulated mass, often with serrated border
  • Often subcapsular, may have satellite nodules
  • More extensive fibrosis than fibrolamellar variant, no radiating fibrous bands, no central scar
  • Gross appearance may be similar to intrahepatic cholangiocarcinoma
Gross images

Images hosted on other servers:

Scirrhous HCC

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Ryan M. Gill, M.D., Ph.D.

Unencapsulated

Fibrous stroma

Cytologic features


CK7

Glypican 3

HepPar1

Cytology description
  • Cells are polygonal with distinct cell membranes, high N/C ratio, round nuclei, may have prominent nucleoli (similar to moderately differentiated HCC)
Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Liver, mass, core biopsy:
    • Scirrhous hepatocellular carcinoma; see comment
    • Comment: This tumor shows histologic features of scirrhous hepatocellular carcinoma with nests and trabecula of hepatoid cells within a dense fibrous stroma. The tumor cells show positive staining for glypican 3, arginase1 and CK7, as is typical for this variant.
Differential diagnosis
Board review question #1
Which of the following is true regarding this variant of hepatocellular carcinoma?



  1. Abundant eosinophilic cytoplasm
  2. Abundant fibrous stroma
  3. Central scar
  4. Lamellar fibrous bands
  5. Prominent nucleoli
Board review answer #1
B. Abundant fibrous stroma

Comment Here
Board review question #2
Which of the following is true regarding the scirrhous variant of hepatocellular carcinoma?

  1. Association with hypocalcemia has been described
  2. CK7 and CK19 are often negative
  3. It is associated with TSC1 / TSC2 mutations
  4. There is often necrosis or hemorrhage
Board review answer #2
C. It is associated with TSC1 / TSC2 mutations

Comment Here
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