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Year : 2008  |  Volume : 51  |  Issue : 3  |  Page : 459-460
The significance of cell block and fine needle aspiration cytology in diagnosing a rare presentation of hepatocellular carcinoma


Department of Pathology, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore, Tamil Nadu, India

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How to cite this article:
Pillai SB, Shanthakumari S. The significance of cell block and fine needle aspiration cytology in diagnosing a rare presentation of hepatocellular carcinoma. Indian J Pathol Microbiol 2008;51:459-60

How to cite this URL:
Pillai SB, Shanthakumari S. The significance of cell block and fine needle aspiration cytology in diagnosing a rare presentation of hepatocellular carcinoma. Indian J Pathol Microbiol [serial online] 2008 [cited 2021 Oct 19];51:459-60. Available from: https://www.ijpmonline.org/text.asp?2008/51/3/459/42538


Sir,

Fine needle aspiration cytology (FNAC) is an excellent diagnostic method for mass lesions in the liver. We report a case of hepatocellular carcinoma (HCC) with rare cytological and clinical features which led to a diagnostic dilemma. The cell block preparation helped us to arrive at a diagnosis.

An 18-year-old female presented with pain over both shoulders and abdomen. She had diffuse tenderness over the abdomen and was not jaundiced.

Spiral CT revealed enlarged liver with multiple hypodense, contrast-enhancing lesions in both lobes of the liver. The largest one measured 8.2 5.9 cm. Moderate free fluid was detected in the peritoneum and tapping was done. A radiological diagnosis of secondary metastatic deposit was considered and FNAC of the lesion was done. Smears and cell block preparations were made.

Liver function tests revealed elevated liver enzymes. Alpha fetoprotein (AFP) was markedly elevated >1000 IU/mL (normal <11.3 IU/mL). Cytological examination of ascitic fluid showed no malignancy.

Fine needle aspiration cytology liver showed highly cellular smears with sheets and papillary clusters of pleomorphic round cells, having scant cytoplasm, nuclear inclusions and vacuoles [Figure 1]. Single cell dispersion and bare nuclei were present. Bile stasis was absent. A diagnosis of malignant epithelial neoplasm was made. Subsequent cell block section revealed a picture of HCC, with more than 90% of the cells showing multiple intranuclear and cytoplasmic vacuoles.

Hepatocellular carcinoma is commonly seen in adults and it has been reported in children less than 5 years of age. No morphological difference has been reported between the HCC in adults and in the younger age group. But HBsAg carrier rate and the frequency of high serum AFP values were significantly prominent in the younger patients. [1] In this case, the patient was 18 years old and was HBsAg-negative, but AFP level was elevated.

Cytology smears showed cells with multiple intranuclear vacuoles of varying sizes almost occupying the entire nucleus, apart from the characteristic intranuclear inclusions. Correlating with the imaging results, a diagnosis of epithelial malignancy was made. As yolk sac tumors are more common in this age group, a diagnosis of HCC was deferred on cytology. But cell block revealed a picture of HCC with multiple pseudoinclusions in the nucleus. There are very few cases reported with nearly 90% of the cells showing nuclear pseudoinclusions in clusters or groups. Cytoplasmic vacuolations are due to glycogen accumulation, but the cause of nuclear vacuolations is not known and needs further study. [2]

We report this case to enlighten the occurrence of HCC in a young HBsAg-negative patient with a rare cytological finding of multiple intranuclear pseudoinclusions in more than 90% of cells. This report also stresses the importance of cell block preparation in conjunction with FNAC for a more specific diagnosis.

 
   References Top

1.Namieno T, Kawata A. Age-related, different clinicopathologic features of hepatocellular carcinoma patients. Ann Surg 1995;221:308-14.  Back to cited text no. 1    
2.Gupta SK, Das DK, Rajwanshi A, Bhusnurmath SR. Cytology of hepatocellular carcinoma. Diagn Cytopathol 1986;2:290-4.  Back to cited text no. 2  [PUBMED]  

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Correspondence Address:
Suma B Pillai
Department of Pathology, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore - 641 037, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.42538

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