This is a review of the cytologic and clinicopathological findings seen in a series of six fibrolamellar hepatocellular carcinomas (FL-HCC) studied by means of fine-needle aspiration (FNA). A comparison of several cellular measurements (cell, nuclear and nucleolar sizes, and N/C ratios) Key Words: liver; hepatocellular carcinoma; hepatocellular adenoma; focal nodular hyperplasia; morphometry Fine-needle aspiration (FNA) using either ultrasound or computerized tomography (CT) guidance has assumed a pivotal role in the primary evaluation of space-occupying liver lesions (SOLL) and has superseded core biopsy. FL-HCC is a morphologic variant of HCC with distinctive clinical, demographic, radiographic (CT-scan), biochemical, and pathological features; relatively better prognosis and resectability also characterize this tumor. [19][20][21][22] Since one of the histologic features distinguishing this tumor is the presence of large polygonal cells with abundant granular eosinophilic cytoplasm, sharply defined boundaries, and a large vesicular nucleus with a prominent nucleolus, [19][20][21][22] it is reasonable to assume that these cytologic features could also be observed in fine-needle aspirates and that consequently a straightforward cytologic diagnosis could be achieved.The purpose of this article is to describe the cytologic and histologic findings of six FL-HCC studied by means of FNA, and to make some comments about the diagnostic dilemmas posed in the interpretation of fine-needle aspirates. We also put forward a simple morphometric approach to support the cytologic diagnosis of FL-HCC.
Materials and MethodsThe pathology files of two Spanish hospitals were accessed. Five FL-HCC were found in a referral hospital for hepatic transplantation and one FL-HCC in a regional hospital. Medical records of these patients were also reviewed. Histologic sections available for reassessment had been stained with H&E, Masson trichrome, and Gomori reticulin. Well-preserved sections of each case were reviewed independently by two of us (MPG, JSP) and the diagnosis of FL-HCC was confirmed in five cases (Nos. 2-6) using the time-honored histologic criteria put forward
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