Cytologic aspect of fibrolamellar hepatocellular carcinoma in fine‐needle aspirates

Abstract

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(CT) guidance has assumed a pivotal role in the primary evaluation of space-occupying liver lesions (SOLL) and has superseded core biopsy.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

Cytologic features of fibrolamellar carcinoma with mucin production: A rare variant of combined hepatocellular‐cholangiocarcinoma

“…Cytologic features of our case were similar to those previously described FCs . However, to our knowledge, cytologic findings of FC with mucin production have not been previously reported.…”

Detection of Metastatic Fibro-Lamellar Type of Hepato Cellular Carcinoma in Ascitic Fluid Cytology in a Liquid-Based Preparation

“…The trabecular arrangement with transversing capillary channels of conventional HCC is not usually seen. [4][5][6] Some times, FL-HCC may be difficult to differentiate from conventional HCC. As compared to conventional HCC, the smears in the present case did not reveal the "basketing" pattern" or traversing capillaries that are commonly seen in conventional HCC.…”

“…[4][5] Detection of this uncommon variant of HCC on exfoliative cytology poses diagnostic challenges to cyto pathologists, especially when there is no clinical suspicion or clinical details are not known at the time of reporting. We present a unique case of metastatic FL-HCC detected on ascitic fluid cytology and ultrasound-guided fine needle aspiration (US-FNA) of retroperitoneal lymph node.…”

Liver

“…12.21). 118 In contrast to typical HCC, fibrolamellar HCC and pediatric HCCs are more likely to stain positively with CK7 than adult HCCs. 118 In contrast to typical HCC, fibrolamellar HCC and pediatric HCCs are more likely to stain positively with CK7 than adult HCCs.…”