Liver and intrahepatic bile ducts - tumor - Sclerosing variant of hepatocellular carcinoma

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Liver and intrahepatic bile ducts - tumor

Hepatocellular carcinoma

Sclerosing variant

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

General
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● Variant with fibrous septa separating trabecular cell plates, but no lamellar fibrosis
● Also called scirrhous carcinoma
● May not be a distinct histopathologic entity

Clinical features
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● 1-4% of all hepatocellular carcinoma
● Associated with hypercalcemia and hypophosphatemia, but not with bone metastases
● Better prognosis (Hepatogastroenterology 2009;56:1086)

Gross description
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● Single, subcapsular, unencapsulated, large, lobulated, gray-white, firm, circumscribed mass, often with serrated border
● Often satellite nodules
● More diffuse fibrosis than fibrolamellar variant, no radiating fibrous bands, no central scar and usually no cirrhosis
● Cirrhosis usually similar to classic HCC

Micro description
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● Fibrous septa separate trabecular cell plates, but no lamellar fibrosis
● Cell plates 3 or more cells thick
● Tumor cells may have pseudoglandular (acinar) features compared to fibrolamellar variant, are smaller, lack vesicular nuclei and prominent nucleoli and have less abundant and granular cytoplasm
● No apparent endothelial sinusoidal cells

Positive stains
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● AFP

Negative stains
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● Mucin

Differential diagnosis
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● Cholangiocarcinoma: similar if neoplastic cells arranged as narrow tubular structures resembling bile ductules
● Metastatic carcinoma of pancreas: usually less dense sclerosis
● Fibrolamellar variant: less diffuse fibrosis; has radiating fibrous bands, central scar, lamellar fibrosis, usually no cirrhosis
● Epithelioid hemangioendothelioma: CD34+, factor VIII+, mucin-
● Post-chemoradiation therapy

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

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