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Hepatocellular carcinoma (view source)
Revision as of 19:34, 28 December 2016
, 19:34, 28 December 2016→Images: added case
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Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies. | Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies. | ||
[[File:5 04760075043191 sl 1.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
[[File:5 04760075043191 sl 2.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
[[File:5 04760075043191 sl 3.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
[[File:5 04760075043191 sl 4.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
[[File:5 04760075043191 sl 5.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
[[File:5 04760075043191 sl 6.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
[[File:5 04760075043191 sl 7.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
[[File:5 04760075043191 sl 8.png| Hepatocellular carcinoma arising in cirrhosis]] | |||
Hepatocellular carcinoma superimposed on cirrhosis in a 60 year old man. A. Dark tumor, sometimes with separate cords visible at low power (black arrow), contrasts with lightly colored regenerative nodules (green arrows) within fibrotic bands. B. Regenerative nodules are separated by a band with proliferated bile ducts, whose orientation, lacking haphazard spread, bespeaks a benign process. C. Reticulin of regenerative nodule shows two cell thick cords lacking orientation, disrupted without reason, aggregated and, at left, slighely dispersed. D. Hepatocellular carcinoma shows darker cytoplasm and more nuclei per square mm than regenerative nodules. Note the many acini, also a good sign of cancer. E. Reticulin fibers have disappeared, leaving cords with 6 or more nuclei thick in places. F. PAS D stain shows benign proliferated bile ducts, whose orientation from lower left to upper right deprives the proliferation of the haphazard nature of a cholangiocarcinoma. G. PAS-D shows the cytoplasmic digestion of glycogen in a hepatocellular carcinoma, a helpful hint at times. Note the finger like cords, the mitosis (black arrow), and the occasional acinar lumens (red arrows). H. PAS D of regenerative nodule contrasts with the image of the hepatocellular carcinoma. | |||
===Fibrolamellar hepatocellular carcinoma=== | ===Fibrolamellar hepatocellular carcinoma=== | ||