Cytologic diagnosis of brain metastasis from hepatocellular carcinoma by squash preparation

Abstract

Hepatocellular carcinoma (HCC) metastasizes to the brain is rare instances. In published series and case reports of metastatic HCC, diagnosis of central nervous system metastases has been determined by histologic methods. We present a case of metastatic HCC of brain diagnosed by squash cytologic preparation. A 69-year-old male, HCV positive, suffering from post-hepatitic cirrhosis, initially diagnosed at age 68 with HCC presented with headaches of increasing frequency and severity. A computed tomography scan confirmed a 3-cm nodule in the right parietal lobe of the brain. Squash cytology was performed intraoperatively and preparations of a small tissue fragment resected from the mass showed medium-to-large-sized, well-cohesive clusters or sheets of uniform tumor cells. The tumor cells are highly cellular and contain solitary tumor cells in loose groupings as well as many fragments. They also appear somewhat bizarre and contain large, round, or ovoid nuclei with prominent nucleoli. Cytologic diagnosis of metastatic HCC was rendered reported and confirmed by a subsequent frozen section examination. To the best of our knowledge, this is the first reported case in which HCC was reported as brain metastasis, by using squash cytology. We suggest that intraoperative squash cytologic examination be viewed as a useful initial approach in the diagnosis of metastatic brain tumor.

Intraoperative liquid‐based cytology of rinsed tissue fragments from head and neck lesions

“…However, the cytological findings of brain lesions have not been described in LBC samples because preoperative cytological diagnosis is not commonly practiced. Consequently, brain cytology usually entails just tumor imprints of metastatic lesions and/or squash cytology samples collected intraoperatively . However, the diagnostic contribution of these cytological preparations is limited by artifacts (eg, cell rupture) .…”

“…Consequently, brain cytology usually entails just tumor imprints of metastatic lesions and/or squash cytology samples collected intraoperatively. 4,[10][11][12][13] However, the diagnostic contribution of these cytological preparations is limited by artifacts (eg, cell rupture). 14 In addition, hard tissues (eg, those with calcifications) are generally not suitable for frozen section preparation.…”

Microvascular proliferation of brain metastases mimics glioblastomas in squash cytology

“…Abnormal vascular proliferation is an important feature in the histological and cytological diagnosis of tumours, including brain tumours. However, cytological analysis of the vasculature of primary gliomas or metastatic brain tumours is rarely reported . This study showed that microvascular proliferations were frequent in metastatic tumours, whereas none were identified in normal/reactive brain tissues and the majority of grade II DA/ODGs.…”

Cytologic Features of Hepatoid Carcinoma of the Ovary

“…In addition, a few groups showed a peripheral endothelial rim. This pattern, which is characteristic of HCC and has been described in squash preparations of metastatic HCC, 19 is useful in recognizing hepatic differentiation. Such a trabecular pattern reflects the hepatocellular nature of the neoplasm and must be considered a diagnostic clue because it is rare in other ovarian carcinomas.…”