Liver & intrahepatic bile ducts

Hepatocellular carcinoma

Macrotrabecular massive

Editorial Board Member: Raul S. Gonzalez, M.D.
Editor-in-Chief: Debra L. Zynger, M.D.
Rong Xia, M.D., Ph.D.
Xuchen Zhang, M.D., Ph.D.

Topic Completed: 10 October 2019

Minor changes: 6 May 2021

Copyright: 2019-2021, Inc.

PubMed Search: Macrotrabecular Hepatocellular Carcinoma

Rong Xia, M.D., Ph.D.
Xuchen Zhang, M.D., Ph.D.
Page views in 2020: 4,328
Page views in 2021 to date: 1,732
Cite this page: Xia R, Zhang X. Macrotrabecular massive. website. Accessed November 27th, 2021.
Definition / general
Essential features
  • Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC)
  • Macrotrabecular hepatocellular carcinoma (MT-HCC)
ICD coding
  • Liver
  • Based on light microscopic examination of tissue with compatible histomorphology findings (hepatocellular carcinoma with > 50% growth of macrotrabecular pattern (≥ 6 - 10 cells thick))
Prognostic factors
  • Surgical resection
  • Radiofrequency ablation
  • Transarterial chemoembolization (TACE)
  • Transplantation
Gross description
Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Xuchen Zhang, M.D., Ph.D.
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Macrotrabeculae with anaplastic cells

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Macrotrabecular pattern

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Macrotrabecular pattern

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Macrotrabeculae with cytologic atypia

Positive stains
Negative stains
Molecular / cytogenetics description
Sample pathology report
  • Liver, segment 5, mass, biopsy:
    • Hepatocellular carcinoma, poorly differentiated, with macrotrabecular pattern (see comment)
    • Comment: Histologic sections show thickened cords are composed of polygonal tumor cells with distinct cell membranes, eosinophilic cytoplasm, high N/C ratio, prominent nucleoli, conspicuous mitoses and necrosis. The thickened cords contain more than 6 - 10 cells thick tumor cells consistent with macrotrabecular pattern. This pattern of hepatocellular carcinoma has been recently categorized as macrotrabecular massive subtype.
  • Liver, right lobe, right hepatectomy:
    • Poorly differentiated hepatocellular carcinoma, macrotrabecular massive subtype (see comment and synoptic report)
    • Nonneoplastic background liver with chronic hepatitis B and portal fibrosis (grade 1 of 4, stage 1 of 4)
    • Comment: The current hepatocellular carcinoma shows mixed histologic growth pattern with acinar, trabecular and macrotrabecular patterns. The tumor cells in the macrotrabeculae (≥ 6 - 10 cells thick) show marked nuclear pleomorphism with numerous mitoses and prominent nucleoli. Anaplastic giant tumor cells are present. Immunohistochemical stains show that the tumor cells are positive for arginase1, HepPar1 and focally positive for glypican 3. Peritumoral microvascular invasion is present. Also noted grossly is that there is a tumor thrombus in one of the portal vein branches and this is confirmed microscopically.
Differential diagnosis
  • Trabecular hepatocellular carcinoma: hepatocellular carcinoma with trabecular growth pattern of < 6 cells thick
Board review style question #1
    Which of the following hepatocellular carcinoma subtypes is associated with worse prognosis?

  1. Clear cell subtype
  2. Macrotrabecuar massive subtype
  3. Fibrolamellar
  4. Lymphocyte rich
  5. Steatohepatitic
Board review style answer #1
B. Macrotrabecuar massive subtype

Comment Here

Reference: Macrotrabecular massive hepatocellular carcinoma
Board review style question #2

    Which of the following molecular features is associated with macrotrabecular massive hepatocellular carcinoma?

  1. TP53 mutation or FGF19 amplification
  2. CTNNB1 mutations
  3. RB1 mutation
  4. Chromosomal alteration
  5. TERT promoters mutation
Board review style answer #2
A. TP53 mutation or FGF19 amplification

Comment Here

Reference: Macrotrabecular massive hepatocellular carcinoma
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