Fine‐needle aspiration cytology and differential diagnoses of fibrolamellar hepatocellular carcinoma metastatic to the mediastinum: Case report

Abstract

We report a case of fibrolamellar hepatocellular carcinoma (FL-HCC) that metastasized to the posterior mediastinum. The diagnosis was made on fine-needle aspiration biopsy (FNAB). The cytologic features were characterized by the presence of large, dishesive, polygonal cells with granular cytoplasm and well-defined cell outlines resembling oncocytes. Groups of neoplastic hepatocytes containing bile pigment were also noted. The diagnosis of FL-HCC in a metastatic site can pose diagnostic challenges on FNAB. The cytologic features overlap with a variety of tumors that have oncocytic features and also with melanoma and paraganglioma. Recognition of specific cytologic features of FL-HCC can facilitate accurate diagnosis in a metastatic site. The cytologic findings and differential diagnoses of FL-HCC that metastasized to the posterior mediastinum are discussed.

Fibrolamellar hepatocellular carcinoma: A case report with cytological features in a sixteen-year-old girl

“…These findings have also been described in classic HCC but rarely documented in FL-HCC. 5,7 A pseudoglandular pattern with bile plugs in centrally located canaliculi is also rarely mentioned in this type of tumor, 3,8 but was observed in the surgical specimen in our case.…”

“…10,11 The patient was first treated with chemotherapy because of the suspicious lung lesions but the tumor proved to be resistant, confirming findings in the literature. 3,8 A wide resection of the tumor and metastases, therefore, seemed to be the adequate treatment in this case.…”

“…Since Edmondson first described fibrolamellar hepatocellular carcinoma (FL-HCC) in 1956, a few cases concerning this rare entity have been reported in the cytopathology literature. [1][2][3] FL-HCC is characterized histologically by well-differentiated malignant hepatocytes with large and deeply eosinophilic granular cytoplasm. It accounts for 1-9% of all HCC in the general population but rises to 30% in patients younger than 20 yr. FL-HCC occurs mostly in children above 10 yr of age but has been reported in childhood as early as the age of 5 yr. 4 We report a case diagnosed by cytopathology and confirmed by histological examination of the corresponding biopsy specimen and then the subsequent surgical specimen.…”

Diagnosis of metastatic fibrolamellar hepatocellular carcinoma by endoscopic ultrasound-guided fine needle aspiration

“…recently reported a case of metastatic FL-HCC that presented with large bilateral ovarian metastases and was diagnosed by FNA of the left ovary. [7] Before the present case, there has been only one other report[8] to our knowledge that demonstrates metastasis of FL-HCC in the mediastinum. Unlike this prior report, FNA in the present case was performed under EUS guidance.…”

“…[6] Use of FNA has been rarely reported in the diagnosis of metastatic FL-HCC. [78] Montero et al . recently reported a case of metastatic FL-HCC that presented with large bilateral ovarian metastases and was diagnosed by FNA of the left ovary.…”