Ch. 13 - Liver Flashcards
What types of liver pathology are amenable to FNA sampling?
Liver masses; not for diffuse disease (cirrhosis, hepatitis) which relies on architecture for Dx.
What are the normal cellular elements of liver?
Hepatocytes, bile duct epithelium, Kupffer cells, and sheets of mesothelial cells.
Describe the morphology of hepatocytes.
Large polygonal cells with round central nuclei (sometimes multinucleated). Cytoplasm is abundant and granular and may contain lipofuscin, hemosiderin, or bile. Look for trabeculae.
Describe the morphology of bile duct epithelium and Kupffer cells.
Bile duct epithelium: Cuboidal/flat cohesive cells arranged in honeycombs.
Kupffer cells: Basically macrophages, sometimes hemosiderin-laden.
Describe the cytology of bacterial/fungal and amebic abscesses.
Bacterial/fungal: Acute infiltrate, debris, maybe organisms
Amebic: Anchovy paste gross appearance. Necrosis with little inflammation. Trophozoites (resemble histiocytes with ingested RBCs).
Describe the cytology of echinococcal cysts.
Fragments of laminated membrane, sometimes with scolices or hooklets.
What types of non-parasitic cysts can be found in the liver?
Cuboidal or columnar (biliary), ciliated, mucinous (bile duct cystadenoma).
Describe the cytology of cirrhosis.
Normal appearing hepatocytes, maybe some steatosis and focal atypia. Need to get core biopsy…
Describe the cytology of FNH.
Normal looking hepatocytes, maybe some steatosis and bile ductular cells.
Distinguish between the clinical significance and cytology of FNH and hepatic adenoma.
Both affect adult women. FNH can be recognized clinically by its radiologic central scar. Bile duct epithelium should not be seen in hepatic adenoma, which also confers a minor risk of HCC transformation.
Describe the cytology of hepatic adenoma.
Normal appearing hepatocytes, some steatosis and naked arterioles.
Describe the cytology of bile duct hamartoma (“von meyenberg complex”).
Hypocellular specimen containing many benign ductal cells and some hepatocytes.
Describe the cytology of liver angioma.
3-D arcades of spindled cells with blood, maybe some hepatocytes.
When is hepatic angiomyolipoma sampled?
Only when it is fat-poor and cannot be recognized as AML on imaging, analogous to those of the retroperitoneum.
Describe the cytology of angiomyolipoma.
Fat cells, blood vessels, and spindled to epithelioid myoid cells. May have some EMH.
What are some normal markers of benign hepatocytes?
HepPar1, TTF-1 (cytoplasmic only), ARG-1, CAM5.2, polyclonal CEA (canalicular pattern).
What are the three architectural patterns of usual HCC?
Trabecular, pseudoglandular (acinar), and compact.
What are the variants of HCC?
Fibrolamellar (young pts, good px) Sarcomatoid Scirrhous Lymphoepithelioma-like Undifferentiated
What histologic features are distinct for HCC?
Hyaline (Mallory) bodies, globular hyaline bodies, and bile.
Describe the cytology of well-differentiated HCC.
Highly cellular smears of enlarged hepatocytes with high N:C ratios arranged in thick plates. Hyaline intracytoplasmic globules.
Describe the cytology of HCC, fibrolamellar variant
Large polygonal cells with abundant eosinophilic cytoplasm and dense bands of fibrosis. Hyaline intracytoplasmic globules.
Describe the cytology of cholangiocarcinoma.
Isolated cells or crowded sheets with glandular differentiation and nuclear enlargement.
What are the risk factors for cholangiocarcinoma. Where can they occur?
Liver fluke, PSC, nonbiliary cirrhosis, thorotrast, vinyl chlorides. May be intrahepatic or extrahepatic (hilar = “Klatskin”).
Describe the cytology of hepatoblastoma.
Similar to that of HCC but within the spectrum of SRBCTs
Describe the cytology of angiosarcoma.
May be well-differentiated (spindled, syncytial) or poorly differentiated (epithelioid, even rhabdoid). Vacuolated cytoplasm. Look for anastomosing vascular pattern on cell blocks.
Describe the cytology of epithelioid hemangioendothelioma.
Hypocellular specimen; large polymorphous cells with folded nuclear outline and some giant cells.
What cancers are very likely to metastasize to liver?
Colorectal, lung, pancreas, stomach, and breast.
What stains are helpful for distinguishing HCC from benign liver?
Reticulin stain (for architecture, generally not helpful in cytology) and glypican-3 (GPC3) which is positive in HCC but not benign hepatocyte.
What stains are helpful for diagnosing NETs? What about pancreatic NETs?
Synaptophysin, chromogranin, CD56.
Pancreatic: Islet-1 and PAX-8.
What stains distinguish seminoma/dysgerminoma from embryonal carcinoma and yolk sac tumor?
Seminoma: PLAP, CD117, OCT-3/4, NANO-G, SALL4.
Embryonal/Yolk: AFP, EMA, CEA, Keratins.
