Liver & intrahepatic bile ducts

Hepatocellular carcinoma

HCC - macrotrabecular massive


Editorial Board Members: Monika Vyas, M.D., Raul S. Gonzalez, M.D.
Rong Xia, M.D., Ph.D.
Xuchen Zhang, M.D., Ph.D.

Last author update: 16 December 2022
Last staff update: 16 December 2022

Copyright: 2019-2024 PathologyOutlines.com, Inc.

PubMed Search: Macrotrabecular hepatocellular carcinoma

Rong Xia, M.D., Ph.D.
Xuchen Zhang, M.D., Ph.D.
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Cite this page: Xia R, Neto AG, Zhang X. HCC - macrotrabecular massive. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/macrotrabecularhepatocellularcarcinoma.html. Accessed April 14th, 2024.
Definition / general
Essential features
Terminology
  • Macrotrabecular massive hepatocellular carcinoma (MTM HCC)
  • Macrotrabecular hepatocellular carcinoma (MT HCC)
ICD coding
  • ICD-O: 8170/3 - hepatocellular carcinoma
  • ICD-11: 2C12 & H00048 - malignant neoplasms of liver or intrahepatic bile ducts & hepatocellular carcinoma
Epidemiology
Sites
  • Liver
Etiology
Diagnosis
  • Based on light microscopic examination of tissue with compatible histomorphology findings (hepatocellular carcinoma with > 50% growth having a macrotrabecular pattern [≥ 6 - 10 cells thick])
Laboratory
Prognostic factors
Treatment
  • Surgical resection
  • Radiofrequency ablation
  • Transarterial chemoembolization (TACE)
  • Transplantation
Gross description
Microscopic (histologic) description
Microscopic (histologic) images

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

Macrotrabeculae with anaplastic cells

Macrotrabecular pattern Macrotrabecular pattern

Macrotrabecular pattern

Macrotrabeculae with cytologic atypia

Macrotrabeculae with cytologic atypia



Contributed by @liverwei on Twitter
Macrotrabecular massive hepatocellular carcinoma Macrotrabecular massive hepatocellular carcinoma

Macrotrabecular massive hepatocellular carcinoma


Contributed by @RaulSGonzalezMD on Twitter
Macrotrabecular massive hepatocellular carcinoma Macrotrabecular massive hepatocellular carcinoma

Macrotrabecular massive hepatocellular carcinoma

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 that 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 acinar, trabecular and macrotrabecular histologic patterns. The macrotrabecular pattern component accounts for 70% of the entire tumor. 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; this is confirmed microscopically.
Differential diagnosis
Board review style question #1
Which of the following hepatocellular carcinoma subtypes is associated with worse prognosis and frequent vascular invasion?

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

Comment Here

Reference: HCC - macrotrabecular massive
Board review style question #2

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

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

Comment Here

Reference: HCC - macrotrabecular massive
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