Cytomorphological variables of hepatic malignancies in fine needle aspiration smears with special reference to grading of hepatocellular carcinoma

Abstract

Background:The evaluation and management of discrete hepatic masses is a clinical problem. Ultrasound guided fine needle aspiration cytology (FNAC) is a rapid, accurate and safe diagnostic procedure that can be used in various neoplastic and non-neoplastic diseases of the liver.Aim:To evaluate the cytomorphological features of hepatocellular carcinoma.Materials and Methods:Ultrasound-guided fine needle aspiration was performed on 52 patients clinically suspected of having hepatic lesion.Results:Malignancy was detected in 50 cases. The primary malignancies consisted of 15 cases of hepatocellular carcinoma (HCC), 4 cases of cholangiocarcinoma and 2 of hepatoblastoma. There were 29 metastatic lesions, which included 26 cases of adenocarcinoma, 2 cases of squamous cell carcinoma and 1 of lymphoma. The key diagnostic features for HCC were trabecular arrangement, polygonal cells with eosinophilic and granular cytoplasm, hyperchromatic nuclei with macronucleoli. Atypical naked hepatocytic nuclei and malignant cells separated by sinusoidal capillaries were also commonly seen. The sensitivity and specificity of FNA for malignancies was found to be 96% and 100% respectively, yielding a positive predictive value of 100% and negative predictive value of 50%.Conclusions:There was a very good correlation of cytological criteria and histopathological diagnosis in hepatocellular carcinoma of various grades as well as in differentiating primary from metastatic tumors. It is recommended that image directed FNAC should be the primary diagnostic modality for assessing potential malignancy in any patient with a localized hepatic mass.

Role of ultrasound guided fine needle aspiration cytology of right hypochondrial masses

“…Results of Iqbal (M:F-1:3.5), Nazir Sidhalingreedy sharda were comparable with our study. [1][2][3][4] Out of total 100 cases, 83 (83%) cases were malignant, 7 (7%) cases benign and 10 (10%) cases inconclusive due to low cellularity. Among the malignant masses, majority 52 (52.0%) cases were of liver secondaries followed by 24 (24.0%) cases of adenocarcinoma gall bladder, 5 (5.0%) cases of primary hepatocellular carcinoma (HCC) and 1 (1%) case each of cholangiocarcinoma GB and squamous cell carcinoma GB.…”

Fine needle aspiration in the diagnosis and classification of hepatoblastoma

“…Fine needle aspiration (FNA) is a rapid and safe alternative to core or open biopsy for the diagnostic work-up of hepatic and other abdominal lesions in children. [10][11][12][13][14] However, in many centers, the use of FNA alone is judged insufficient to make a final diagnosis and histological material using core needle biopsy (CNB) or excisional biopsy is needed for confirmation and especially correct determination of the histological tumor subtype. [15][16][17] There is only a limited number of reports in the literature regarding FNA in HBL, most of them being single case reports (Table I).…”

Role of fine‐needle aspiration in post liver transplant patients: A clinical/cytological review

“…And nowadays with the help of ancillary studies the diagnosis However, difficulty in cytological diagnosis arises at the end of malignant spectrum that is, distinguishing well differentiated HCC from a benign liver lesion and separating less differentiated HCC from metastatic malignancies. 20 In our study there were eight recurrences of HCC, six in the liver and two patients had metastatic disease to the iliac bone and periportal lymph node. In all cases a diagnosis of HCC was rendered on the FNA material and was confirmed with ancillary studies ( Table 1)…”

“…And nowadays with the help of ancillary studies the diagnosis of hepatocellular carcinoma can be reached in the majority of cases. However, difficulty in cytological diagnosis arises at the end of malignant spectrum that is, distinguishing well differentiated HCC from a benign liver lesion and separating less differentiated HCC from metastatic malignancies …”