Hepatocellular carcinoma: Difference between revisions
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→Microscopic evaluation: +Steatotic |
→Differentiation: Reporting |
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*Abundant granular '''eosinophilic cytoplasm''' | *Abundant granular '''eosinophilic cytoplasm''' | ||
*'''Nuclei''' with increased N/C ratio, round nuclei with coarse chromatin and thickened nuclear membrane, and may have prominent nucleoli. | *'''Nuclei''' with increased N/C ratio, round nuclei with coarse chromatin and thickened nuclear membrane, and may have prominent nucleoli. | ||
<gallery mode=packed heights=200> | <gallery mode=packed heights=200> | ||
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File:Hepatocellular Carcinoma, FNA Clot Section (2331528214).jpg|FNA clot section. | File:Hepatocellular Carcinoma, FNA Clot Section (2331528214).jpg|FNA clot section. | ||
</gallery> | </gallery> | ||
{{Hepatocellular adenoma versus carcinoma}} | |||
===Differentiation=== | ===Differentiation=== | ||
Differentiations of hepatocellular carcinoma are:<ref name=Deepali/> | Differentiations of hepatocellular carcinoma are:<ref name=Deepali/> | ||
*'''Well differentiated''': | *'''Well differentiated''': | ||
:*Thin plates (1 - 3 hepatocytes thick) | :*Thin plates (1 - 3 hepatocytes thick) | ||
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:*Minimal nuclear atypia | :*Minimal nuclear atypia | ||
:*Nuclear density of 2x compared to normal liver | :*Nuclear density of 2x compared to normal liver | ||
*'''Moderately differentiated''': | *'''Moderately differentiated''': | ||
:*Trabecular pattern at least 4 cells thick | :*Trabecular pattern at least 4 cells thick | ||
| Line 41: | Line 39: | ||
:*Distinct nucleoli | :*Distinct nucleoli | ||
:*Pseudoglands | :*Pseudoglands | ||
*'''Poorly differentiated''': | *'''Poorly differentiated''': | ||
:*Large tumor cells with hyperchromatic nuclei in compact growth pattern | :*Large tumor cells with hyperchromatic nuclei in compact growth pattern | ||
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:*Prominent pleomorphism | :*Prominent pleomorphism | ||
:*May have spindle cell or small cell areas | :*May have spindle cell or small cell areas | ||
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File:Histopathology of well-differentiated hepatocellular carcinoma.jpg|Well-differentiated HCC. | |||
File:Histopathology of moderately differentiated hepatocellular carcinoma.jpg|Moderately differentiated HCC. | |||
File:Histopathology of poorly differentiated hepatocellular carcinoma.jpg|Poorly differentiated HCC. | |||
</gallery> | |||
==Reporting== | |||
{{CAP}} | |||
{{Reporting}} | |||
{{Bottom}} | {{Bottom}} | ||
Latest revision as of 09:22, 9 September 2021
Author:
Mikael Häggström [note 1]
Presentations
Hepatocellular carcinoma is the most common diagnosis for liver tumors.:[1]
Microscopic evaluation
Hepatocellular carcinoma typically displays:[2]
- Trabecular pattern surrounded by layer of flattened endothelial cells.
- Presence of sinusoidal vessels surrounding tumor cells
- Scant stroma, and minimal desmoplasia
- Polygonal cells with distinct cell membranes
- Abundant granular eosinophilic cytoplasm
- Nuclei with increased N/C ratio, round nuclei with coarse chromatin and thickened nuclear membrane, and may have prominent nucleoli.
-
Needle biopsy.
-
Needle biopsy.
-
Needle biopsy.
-
FNA.
-
FNA clot section.
-
FNA clot section.
Hepatocellular adenoma versus carcinoma
A hepatocellular adenoma, in contrast to a carcinoma, has a well-defined border between the lesion and background liver, and is composed of hepatocytes with less significant cytologic atypia.[4]
Both hepatocellular adenoma and well-differentiated hepatocellular carcinoma may display:
- Steatosis: A steatotic hepatocellular carcinoma is a common variant, found most commonly in small, well-differentiated tumors.[5]
- Portal triads, which commonly persist in well-differentiated hepatocellular carcinomas.[6]
Differentiation
Differentiations of hepatocellular carcinoma are:[2]
- Well differentiated:
- Thin plates (1 - 3 hepatocytes thick)
- Hepatocytes are smaller than normal
- Abnormal reticulin network
- Minimal nuclear atypia
- Nuclear density of 2x compared to normal liver
- Moderately differentiated:
- Trabecular pattern at least 4 cells thick
- Larger cells with more eosinophilic cytoplasm
- Distinct nucleoli
- Pseudoglands
- Poorly differentiated:
- Large tumor cells with hyperchromatic nuclei in compact growth pattern
- Rare trabeculae or bile
- Prominent pleomorphism
- May have spindle cell or small cell areas
-
Well-differentiated HCC. -
Moderately differentiated HCC. -
Poorly differentiated HCC.
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Reporting
For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines.
See also: General notes on reporting
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ Table 37.2 in: Sternberg, Stephen (2012). Sternberg's diagnostic surgical pathology . Place of publication not identified: LWW. ISBN 978-1-4511-5289-0. OCLC 953861627.
- ↑ 2.0 2.1 Deepali Jain. Liver & intrahepatic bile ducts - Hepatocellular carcinoma - Hepatocellular carcinoma overview. PathologyOutlines. Topic Completed: 1 February 2012. Minor changes: 30 September 2020
- ↑ Bioulac-Sage, Paulette; Sempoux, Christine; Possenti, Laurent; Frulio, Nora; Laumonier, Hervé; Laurent, Christophe; Chiche, Laurence; Frédéric Blanc, Jean; et al. (2013). "Pathological Diagnosis of Hepatocellular Cellular Adenoma according to the Clinical Context ". International Journal of Hepatology 2013: 1–13. doi:. ISSN 2090-3448.
- ↑ Author: Avani Pendse, M.D., Ph.D.. Liver & intrahepatic bile ducts - Benign / nonneoplastic - Hepatocellular adenoma. Pathology Outlines. Topic Completed: 1 October 2018. Minor changes: 30 September 2020
- ↑ Chan, Anthony W H; Yu, Shuangni; Yu, Yau-Hei; Tong, Joanna H M; Wang, Lei; Tin, Edith K Y; Chong, Charing C N; Chan, Stephen L; et al. (2016). "Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse ". Histopathology 69 (6): 971–984. doi:. ISSN 03090167.
- ↑ Motohashi, Ikuko; Okudaira, Masahiko; Takai, Tomoko; Kaneko, Satoshi; Ikeda, Noriaki (1992). "Morphological differences between hepatocellular carcinoma and hepatocellular carcinomalike lesions ". Hepatology 16 (1): 118–126. doi:. ISSN 02709139.
Image sources