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Bohara S, Shukla P, Shah S, Chaturvedi R, Singh K. Utility of guided FNAC and cell block preparation from liver and gall bladder masses: Learning experience from a tertiary care center. J Cancer Res Ther 2024:01363817-990000000-00044. [PMID: 38261468 DOI: 10.4103/jcrt.jcrt_172_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Ultrasound- and CT-guided fine needle aspiration cytology (FNAC) increases the accessibility of intra-abdominal masses to the liver and gall bladder with the advantages of low cost and high diagnostic yield. Cell block technique has been known for further increasing the diagnostic accuracy. AIMS AND OBJECTIVES We aimed to study the effectiveness of FNAC and the cell block method in cytological diagnosis of liver and gall bladder masses. We also followed a step-wise approach to increase the success rate. MATERIALS AND METHODS A 2-year observational study was done from July 2020 to June 2022. Total 80 guided (CT and ultrasound) aspirations were done from space occupying/mass lesions in the liver [74 (92.5%)] and gall bladder [6 (7.5%)], out of which cell blocks by the plasma thrombin method were prepared in 12 cases (15%). The on-site radiological details were noted, and rapid on-site evaluation was done in 65 cases (81.25%). The prepared cytology slides were stained with Papanicolaou, H and E and May-Grunwald Giemsa (MGG) stain. The cytological diagnosis was noted, and the uses and limitations (if any) were observed in each case. A step-wise structured questionnaire format was developed to assist the reporting pathologist so as not to miss out on important diagnostic observations, if present. RESULTS FNAC in 71 cases (88.7%) gave a conclusive diagnosis. The maximum number of cases were of adenocarcinoma [38 (51.3%)] from the liver followed by hepatocellular carcinoma in 10 cases (13.5%). In gall bladder masses, all 6 cases (100%) were positive for malignancy, out of which 4 cases (66.7%) could be characterized as adenocarcinoma. The cell block preparation was helpful in reaching the diagnosis as well as typing the malignancy in 10 cases (83.3%). The chief limitation observed on conventional cytology smears was inadequate cellularity, which caused inconclusive diagnosis in 9 cases (11.25%). The reporting questionnaire was helpful chiefly in terms of time-efficient reporting in 34 cases (42.5%), increasing the ease and confidence in 69 cases (86.25%) and the advantage of reproducibility of data in all cases (100%) according to the case-by-case evaluation by the reporting pathologists. CONCLUSION Guided FNAC in conjunction with the cell block technique is extremely helpful in the evaluation of mass lesions of the liver and gall bladder for cytological diagnosis. A proper step-wise approach may be useful to reach a quick and effective diagnosis.
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Affiliation(s)
- Sangita Bohara
- Department of Pathology, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Prakriti Shukla
- Department of Pathology, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Saman Shah
- Department of Pathology, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Rashmi Chaturvedi
- Department of Pathology, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
| | - Kushal Singh
- Department of Radiology, Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India
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Kanda H, Furuta R, Motoi N, Suzuki N, Furuta N, Komatsu K, Sugiyama Y, Saiura A, Sugitani M, Ishikawa Y. Touch cytology smear of an inflammatory hepatocellular adenoma displaying an unusual pattern: A case report. Diagn Cytopathol 2016; 44:1074-1077. [PMID: 27434199 DOI: 10.1002/dc.23541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/06/2016] [Indexed: 11/12/2022]
Abstract
The cytological diagnosis of hepatocellular adenoma (HCA) is difficult since it is a very rare tumor and lacks characteristic cytological features. We have just reported a case of inflammatory HCA that displayed an unusual histological pattern (Clin J Gastroenterol 8:426-434, 2015). A touch cytology smear sample was obtained from the surgical specimen, and it also exhibited very unique features. A 56-year-old male underwent partial hepatectomy for an inflammatory HCA (diameter: 1.4 cm) in the right posterior lobe of the liver. The cytological sample displayed a characteristic two-cell pattern. One type of cells contained thick cytoplasm, a high nucleus/cytoplasmic (N/C) ratio, and well-defined cytoplasmic borders. The other type demonstrated small pyknotic nuclei and a lower N/C ratio. The immunohistochemical staining pattern of the histological specimen suggested that the latter cells might have been undergoing apoptosis. We report a case of inflammatory HCA with characteristic features. To diagnose this type of variant, it is important to recognize the unique pattern described in this study. Diagn. Cytopathol. 2016;44:1074-1077. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hiroaki Kanda
- Department of Pathology, the Cancer Institute of the Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Clinicopathology Center, the Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Reiko Furuta
- Department of Pathology, the Cancer Institute of the Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Department of Medical Laboratory Science, Clinical Cytology, Kitasato University, Kanagawa, Japan
| | - Noriko Motoi
- Department of Pathology, the Cancer Institute of the Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Naoko Suzuki
- Clinicopathology Center, the Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Noriyuki Furuta
- Clinicopathology Center, the Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Kyoko Komatsu
- Clinicopathology Center, the Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Yuko Sugiyama
- Clinicopathology Center, the Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Akio Saiura
- Department of Surgery, the Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Masahiko Sugitani
- Department of Pathology, School of Medicine, Nihon University, Tokyo, Japan
| | - Yuichi Ishikawa
- Department of Pathology, the Cancer Institute of the Japanese Foundation for Cancer Research (JFCR), Tokyo, Japan.,Clinicopathology Center, the Cancer Institute Hospital of JFCR, Tokyo, Japan
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3
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Wee A. Fine needle aspiration biopsy of hepatocellular carcinoma and hepatocellular nodular lesions: role, controversies and approach to diagnosis. Cytopathology 2011; 22:287-305. [PMID: 21762411 DOI: 10.1111/j.1365-2303.2011.00882.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The role of fine needle aspiration (FNA) biopsy of the liver has evolved. Advances in imaging modalities have obviated the need for tissue confirmation in clinically classic hepatocellular carcinoma (HCC). The risks of needle tract seeding and haematogenous dissemination have been actively debated. Nowadays, cytopathologists are confronted by smaller and smaller nodules, detected due to increased surveillance of high-risk cirrhotic patients. Tissue characterization of small well-differentiated hepatocellular nodular lesions (size less than and equal to 2 cm) is extremely challenging and has therapeutic implications. Major issues in the cytodiagnosis of HCC include: (i) distinguishing benign hepatocellular nodular lesions, namely, large regenerative nodules, dysplastic nodules, focal nodular hyperplasia and hepatocellular adenoma from reactive hepatocytes; (ii) distinguishing well-differentiated HCC from benign hepatocellular nodular lesions; (iii) distinguishing poorly differentiated HCC from intrahepatic cholangiocarcinoma and metastatic carcinomas; (iv) determining the histogenesis of a malignant tumour; and (v) determining the site of origin of a malignant tumour. An overview of the biological evolution and histopathological aspects of dysplastic nodules, small HCCs and 'nodule-in-nodule' lesions is presented in tandem with clinically relevant nomenclature. An algorithmic approach to FNA diagnosis of HCC and hepatocellular nodular lesions is outlined. Optimal results depend on (i) a dedicated radiologist-cytopathologist team; (ii) an on-site cytology service, (iii) a combined cytohistological approach, (iv) immunohistochemistry, and (v) clinicopathological correlation. As we move towards personalized medicine, it is envisaged that hepatic FNA is likely to become a point of care in the management protocol as it takes on the additional role of procurement of tumour and peritumoural tissues for genomic and proteomic profiling to enable targeted molecular therapy.
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Affiliation(s)
- A Wee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore
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4
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Wee A. Fine-needle aspiration biopsy of hepatocellular carcinoma and related hepatocellular nodular lesions in cirrhosis: controversies, challenges, and expectations. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:587936. [PMID: 21789263 PMCID: PMC3135134 DOI: 10.4061/2011/587936] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 05/03/2011] [Indexed: 12/13/2022]
Abstract
The role of hepatic fine-needle aspiration (FNA) biopsy has evolved. Advances in imaging modalities have obviated the need for tissue confirmation in most hepatocellular carcinomas (HCCs). There is risk of needle-tract seeding. Increasingly, small nodules are being detected on ultrasound surveillance of high-risk patients. Diagnostic challenges associated with cirrhosis include distinction of benign hepatocellular nodules, namely, large regenerative nodules and dysplastic nodules, from reactive hepatocytes; and distinction of well-differentiated HCCs from benign hepatocellular nodules. This paper will discuss (i) controversies regarding preoperative/pretransplantation FNA diagnosis of HCC, (ii) update of biological evolution, nomenclature, and histopathologic criteria for diagnosis of precancerous nodules and small HCCs, and (iii) algorithmic approach to FNA diagnosis of hepatocellular nodules. Optimal results depend on dedicated radiologist-cytopathologist team, on-site cytology service; combined cytohistologic approach, immunohistochemistry, and clinicopathologic correlation. Hepatic FNA is likely to be incorporated as a point of care as we move towards personalized medicine.
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Affiliation(s)
- Aileen Wee
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Rowe LR, Mulvihill SJ, Emerson L, Gopez EV. Subcutaneous tumor seeding following needle core biopsy of hepatocellular carcinoma. Diagn Cytopathol 2008; 35:717-21. [PMID: 17924404 DOI: 10.1002/dc.20717] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic tumor and one of the most common cancers worldwide. At present, there are two widely used and accepted methods for obtaining diagnostic material for establishing the likelihood of malignancy in a hepatic mass, namely fine-needle aspiration (FNA) cytology and needle core biopsy (NCB). In recent years, however, tumor cell seeding along the needle tract has been shown to be a risk associated with using these procedures to obtain a pathologic diagnosis. We report a case of a patient who presented with a nodule in the anterior abdominal wall at the expected location of the previous NCB tract. FNA biopsy of the abdominal wall lesion confirmed the presence of malignant cells consistent with HCC. The finding of tumor seeding within a NCB tract raises the question of the role of NCB in the diagnostic workup of focal liver lesions.
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Affiliation(s)
- Leslie R Rowe
- Institute for Clinical and Experimental Pathology, Associated Regional and University Pathologists Laboratories, Salt Lake City, Utah, USA
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6
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Sala Llinàs M, Pagés M, Solé M. [A 73-year-old male with multiple hepatic lesions]. Med Clin (Barc) 2007; 129:551-6. [PMID: 17983535 DOI: 10.1157/13111423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Feng X, Zhang H, Liu H, Song X, Wang G, Chen K, Ling S. Cancerogenic effect of different fragments of the hepatitis C virus core protein. Eur J Cancer Prev 2007; 16:304-11. [PMID: 17554203 DOI: 10.1097/01.cej.0000236252.16855.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The hepatitis C virus core protein plays an extremely important role in the hepatocarcinogenesis of hepatitis C virus. Little, however, is known about the oncogenic potency of fragments. Thus, the purpose of the present study is to investigate the cancerogenic effects of the different core protein fragments. Two series of recombinant plasmids containing hepatitis C virus core gene fragments encoding the different-length core protein were constructed using plasmid enhanced green fluorescent protein (pEGFP)-C1 and pcDNA3.1(+), respectively. Human hepatocyte L02 cells transiently transfected with pEGFP-C1-based plasmids were subjected to confocal laser scanning microscopy analysis to determine the localization of the different core protein fragments. The stably transfected L02 cells with the pcDNA3.1(+)-based core protein plasmids were used to investigate the ultrastructural effects of the core protein and the tumorigenicity of L02 cells expressing core protein fragments in athymic nude mice. The full-length core protein and Core130-191 were completely localized in the cytoplasm, while Core1-59 existed exclusively in the nucleus. On the other hand, Core50-140 and Core1-140 were observed in both the nucleus and the cytoplasm. Ultrastructural changes of L02 cells expressing the full-length core protein were comprehensive and included, for example, irregular nuclear, increased nuclear/cytoplasmic ratio and mitochondria swelling. The slight changes were observed in the cells expressing Core50-140 and Core130-191, whereas the ultrastructure of the cells expressing Core1-59 remained normal. All the L02 cells stably expressing different fragments of the core protein, with the exception of the C-terminal truncated fragment Core1-59, could induce the occurrence of tumor in the nude mice. The N-terminal fragment of the core protein, Core1-59, was not oncogenic, while the intermediate and posterior segments of the hepatitis C virus core protein had the cancerogenic potency. In view of the existence of many important immunogenic epitopes in it, the core protein anterior segment might be a safer candidate for the development of hepatitis C virus vaccine.
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Affiliation(s)
- Xiaoyan Feng
- Department of Vaccine Engineering, Beijing Institute of Basic Medical Sciences, Beijing, People's Republic of China.
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8
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Wang J, Yang Y, Xia HHX, Gu Q, Lin MCM, Jiang B, Peng Y, Li G, An X, Zhang Y, Zhuang Z, Zhang Z, Kung HF, Wong BCY. Suppression of FHL2 expression induces cell differentiation and inhibits gastric and colon carcinogenesis. Gastroenterology 2007; 132:1066-76. [PMID: 17383428 DOI: 10.1053/j.gastro.2006.12.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2006] [Accepted: 11/16/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS FHL2 (4-1/2 LIM protein 2) is an adapter and modifier in protein interactions that is expressed mainly in the heart and ovary. It functions in a cell type- or promoter-specific manner. The aims of this study were to examine its expression in gastrointestinal cancers and to determine its role in cell differentiation and tumorigenesis. METHODS FHL2 expression in cancerous and normal gastrointestinal cells was detected by reverse-transcription polymerase chain reaction, immunoblotting, and immunohistochemistry. The effect of FHL2 suppression by both antisense and siRNA methods on cell differentiation and growth were evaluated in vitro and in vivo. RESULTS FHL2 expression was up-regulated in gastrointestinal cancer, compared with matched normal tissues. Stable transfection of gastric cancer cell line, AGS, and colon cancer cell line, Lovo, with antisense FHL2 induced lengthened or shuttle-shape morphologic changes with long or dendritic-like cytoplasmic processes and decreased the nuclear:cytoplasmic ratio. FHL2 antisense induced expressions of carcinoembryonic antigen and E-cadherin and the maturation of F-actin. Furthermore, FHL2 antisense inhibited the transcriptions of some oncogenes including cox-2, survivin, c-jun, and hTERT, and suppressed the promoter activity of activator protein-1 and hTERT. Suppression of FHL2 inhibited serum-dependent, anchorage-dependent and -independent cell growth, and suppressed de novo tumor formation in nude mice xenograft. CONCLUSIONS Suppression of FHL2 induces cell differentiation and inhibits tumorigenesis. Antisense or siRNA methods targeting FHL2 is a promising strategy for treatment of gastrointestinal cancers.
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MESH Headings
- Actins/metabolism
- Animals
- Cadherins/metabolism
- Carcinoembryonic Antigen/metabolism
- Cell Differentiation
- Cell Line, Tumor
- Cell Proliferation
- Cell Shape
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/metabolism
- Cell Transformation, Neoplastic/pathology
- Colonic Neoplasms/genetics
- Colonic Neoplasms/metabolism
- Colonic Neoplasms/pathology
- Cyclooxygenase 2/genetics
- Cyclooxygenase 2/metabolism
- Homeodomain Proteins/genetics
- Homeodomain Proteins/metabolism
- Humans
- Inhibitor of Apoptosis Proteins
- LIM-Homeodomain Proteins
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Mice
- Mice, Nude
- Microtubule-Associated Proteins/genetics
- Microtubule-Associated Proteins/metabolism
- Muscle Proteins/genetics
- Muscle Proteins/metabolism
- Neoplasm Proteins/genetics
- Neoplasm Proteins/metabolism
- Proto-Oncogene Proteins c-jun/genetics
- Proto-Oncogene Proteins c-jun/metabolism
- RNA Interference
- RNA, Antisense/metabolism
- RNA, Messenger/metabolism
- RNA, Small Interfering/metabolism
- Stomach Neoplasms/genetics
- Stomach Neoplasms/metabolism
- Stomach Neoplasms/pathology
- Survivin
- Telomerase/genetics
- Telomerase/metabolism
- Time Factors
- Transcription Factor AP-1/metabolism
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Transcription, Genetic
- Transfection
- Transplantation, Heterologous
- Up-Regulation
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Affiliation(s)
- Jide Wang
- Institute for Digestive Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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9
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Wee A. Fine needle aspiration biopsy of the liver: Algorithmic approach and current issues in the diagnosis of hepatocellular carcinoma. Cytojournal 2005; 2:7. [PMID: 15941489 PMCID: PMC1177974 DOI: 10.1186/1742-6413-2-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 06/08/2005] [Indexed: 12/13/2022] Open
Abstract
The role of fine needle aspiration biopsy (FNAB) in the evaluation of focal liver lesions has evolved. Guided FNAB is still useful to procure a tissue diagnosis if clinical, biochemical and radiologic findings are inconclusive. Major diagnostic issues include: (i) Distinction of benign hepatocellular nodular lesions from reactive hepatocytes, (ii) Distinction of well-differentiated hepatocellular carcinoma (WD-HCC) from benign hepatocellular nodular lesions, (iii) Distinction of poorly differentiated HCC from cholangiocarcinoma and metastatic carcinomas, (iv) Determination of histogenesis of malignant tumor, and (v) Determination of primary site of origin of malignant tumor. This review gives a general overview of hepatic FNAB; outlines an algorithmic approach to cytodiagnosis with emphasis on HCC, its variants and their mimics; and addresses current diagnostic issues. Close radiologic surveillance of high-risk cirrhotic patients has resulted in the increasing detection of smaller lesions with many subjected to biopsy for tissue characterization. The need for tissue confirmation in clinically obvious HCC is questioned due to risk of malignant seeding. When a biopsy is indicated, core needle biopsy is favored over FNAB. The inherent difficulty of distinguishing small/early HCC from benign hepatocellular nodular lesions has resulted in indeterminate reports. Changing concepts in the understanding of the biological behavior and morphologic evolution of HCC and its precursors; and the current lack of agreement on the morphologic criteria for distinguishing high-grade dysplastic lesions (with small cell change) from WD-HCC, have profound impact on nomenclature, cytohistologic interpretation and management. Optimization of hepatic FNAB to enhance the yield and accuracy of diagnoses requires close clinicopathologic correlation; combined cytohistologic approach; judicious use of ancillary tests; and skilled healthcare teams.
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Affiliation(s)
- Aileen Wee
- Department of Pathology, National University of Singapore, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Republic of Singapore.
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Yang GCH, Yang GY, Tao LC. Distinguishing well-differentiated hepatocellular carcinoma from benign liver by the physical features of fine-needle aspirates. Mod Pathol 2004; 17:798-802. [PMID: 15044922 DOI: 10.1038/modpathol.3800121] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Distinguishing well-differentiated hepatocellular carcinoma (HCC) from benign hepatic lesions is challenging for pathologists in limited diagnostic material such as needle-core tissue biopsy and fine-needle aspiration (FNA) biopsy. The objective of this study is to test a hypothesis that the fortification of liver by reticulin along single cell plates should protect benign hepatic lesions from breakdown by the force of aspiration and smearing, whereas the decreased reticulin in well-differentiated HCC would result in finely granular FNA smear. The study involved FNA biopsies of 67 cases of well-differentiated HCC and 109 cases of benign hepatic lesions, including cirrhosis (22), liver cell adenoma (8), steatosis (7), focal nodular hyperplasia (6), liver with cholestasis (6), and unremarkable liver sampled from nodular hepatic lesions consistent with the regenerative nodules (60). A slide with the most sample from each case by gross inspection was mixed together. Two observers blinded to the diagnoses were asked to separate the slides into two groups based on smear characteristics by gross inspection. Fragments of rigid fine-needle cores was present in 109 out of 109 cases of benign hepatic lesions but absent in 61 out of 67 cases of well-differentiated HCC, which presented as finely granular smears. The difference is statistically significant. (P<0.001, df=1, chi2=149.3). Using the physical characteristic of liver aspirates as the screening test for malignancy, the sensitivity is 91%, specificity is 100%, positive predictive value is 100%, negative predictive value is 94.8%, and efficiency is 96.6%. In conclusion, the smear characteristics of liver samples in FNA biopsy correlate to their reticulin status on histology. This physical characteristic can be used as the first clue to distinguish malignant and benign liver aspirates prior to microscopic examination.
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Affiliation(s)
- Grace C H Yang
- Department of Pathology, New York University School of Medicine, New York, NY 10016, USA.
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11
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Nicolau C, Catalá V, Vilana R, Gilabert R, Bianchi L, Solé M, Pagés M, Brú C. Evaluation of hepatocellular carcinoma using SonoVue, a second generation ultrasound contrast agent: correlation with cellular differentiation. Eur Radiol 2004; 14:1092-9. [PMID: 15007620 DOI: 10.1007/s00330-004-2298-0] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 02/11/2004] [Accepted: 02/16/2004] [Indexed: 12/17/2022]
Abstract
The appearance of hepatocellular carcinoma (HCC) with contrast-enhanced ultrasound (CEUS) in the vascular phase is described and evaluated as to whether the enhancement pattern correlates with the degree of cellular differentiation. One hundred four HCCs were prospectively evaluated with CEUS using coherent-contrast imaging (CCI) and SonoVue with a low mechanical index (<0.2). The enhancement of HCCs in the vascular phase was analyzed according to the degree of pathological differentiation obtained by fine-needle biopsy. In the arterial phase, all HCCs except for four well differentiated ones (96.2%) showed enhancement ( P<0.05). Histological differentiation of hypoechoic lesions in the early portal phase (7 HCCs; 16%) significantly differed from hyperechoic (1 HCC; 1%) or isoechoic lesions (87 HCCs; 83.6%) ( P<0.05), with a significant probability of a worse differentiation in hypoechoic lesions. Histological differentiation of isoechoic lesions in the late phase (30 HCCs; 28.8%) significantly differed from hypoechoic lesions (74 HCCs; 71.2%) ( P<0.05), with a significant probability of a better differentiation in isoechoic lesions. CEUS using CCI and SonoVue revealed enhancement in the arterial phase in >95% of HCCs, with a few well-differentiated cases not being diagnosed due to the absence of enhancement. Echogenicity in the portal and late phases correlated with cellular differentiation.
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Affiliation(s)
- Carlos Nicolau
- Diagnosis Imaging Center, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain.
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12
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Yang GCH, Yang GY, Tao LC. Cytologic features and histologic correlations of microacinar and microtrabecular types of well-differentiated hepatocellular carcinoma in fine-needle aspiration biopsy. Cancer 2003; 102:27-33. [PMID: 14968415 DOI: 10.1002/cncr.20000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Well-differentiated hepatocellular carcinoma (HCC) in fine-needle aspiration (FNA) biopsy is characterized by trabeculae three or more cells thick wrapped by peripheral endothelium. The authors encountered another pattern that did not fulfill these classic criteria for malignancy yet was proven to be HCC in clinical follow-up. The objective of this study was to characterize the cytologic features of this pattern with histologic correlations. METHODS Over a period of 6.5 years, 14 of 123 cases (11.4%) of HCC from 428 liver aspirates showed the unusual pattern. Their cytologic features were compared with 14 cases of nonneoplastic liver on FNA smears that were processed with Ultrafast Papanicolaou stain, and their histologic features were compared on cell blocks with hematoxylin and eosin stain and reticulin stain. RESULTS The unusual type of well differentiated HCC in FNA smears was characterized by numerous, small hepatocytes with minimal nuclear atypia but reduced cytoplasm, grouped together in microacini of five or more cells and microtrabeculae one or more cells thick of irregular thickness with no apparent peripheral endothelium. Transgressing capillaries were found when the smears were inspected carefully. In histology nine cases that were the compact type of HCC, two cases that were the microacinar type of HCC, and three cases that were the microtrabecular type of HCC. All FNAs showed deficient reticulin framework. All 14 cases of nonneoplastic liver aspirate were characterized by the presence of large tissue fragments that were resistant to smearing. CONCLUSIONS Well differentiated HCC may present as microtrabeculae of irregular thickness one or more cells thick with inapparent peripheral endothelium or as microacini mimicking neuroendocrine carcinoma.
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Affiliation(s)
- Grace C H Yang
- Department of Pathology, New York University School of Medicine, New York, New York 10016, USA.
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Granados R, Aramburu JA, Murillo N, Camarmo E, de la Cal MA, Fernandez-Segoviano P. Fine-needle aspiration biopsy of liver masses: diagnostic value and reproducibility of cytological criteria. Diagn Cytopathol 2001; 25:365-75. [PMID: 11747233 DOI: 10.1002/dc.10025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are many helpful cytological criteria for the diagnosis of liver fine-needle aspiration biopsies (FNABs), but none of them are pathognomonic of primary or metastatic tumors. We analyzed the diagnostic value and reproducibility of 28 cytological parameters in FNABs from 140 hepatic masses, including 29 benign lesions, 49 hepatocellular carcinomas (HCCs), and 62 metastatic tumors, encompassing 48 adenocarcinomas (ACAs). Five different observers evaluated each sample, and the interobserver and intraobserver agreement was studied. Multivariable analysis showed that the criteria more closely associated with malignancy were irregular nuclear contour, three-dimensional cell groups, and atypical naked nuclei. Capillaries separating tumor cells and granular cytoplasm were strongly associated with HCCs, while eccentrically placed nuclei and necrosis were most commonly seen in ACAs and in metastatic tumors. The intraobserver and interobserver agreement was excellent for the final cytological diagnosis, and there was fair to very good interobserver agreement for 22 of the 28 criteria studied. Architectural features were less reproducible than pure cytological criteria. Intraobserver variability was not influenced by the years of experience in the field. A precise and strict definition of terminology rendered a better reproducibility of the cytological criteria.
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Affiliation(s)
- R Granados
- Department of Pathology, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
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14
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Suterwala S, Volk EE, Danforth RD. Aspiration biopsy of osseous metastasis of occult hepatocellular carcinoma: Case report, literature review, and differential diagnosis. Diagn Cytopathol 2001; 25:63-7. [PMID: 11466816 DOI: 10.1002/dc.2004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Fine-needle aspiration (FNA) cytology is a reliable technique for rapid diagnosis in virtually every organ of the body, including bone lesions. We report on the FNA findings in a 61-yr-old male of an osteolytic sacral lesion, which determined the diagnosis of an unsuspected metastatic hepatocellular carcinoma. In this case, the diagnosis was confirmed by FNA biopsy without resorting to surgical biopsy.
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Affiliation(s)
- S Suterwala
- Department of Pathology, St. John Hospital and Medical Center, Detroit, Michigan 48236-2172, USA
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