Clinical history: A 86-year-old male patient with past medical history of chronic Hepatitis C presents with multiple liver lesions. A FNA of the liver lesions was performed to establish the diagnosis.
What is your diagnosis?
Discussion and answer
Well differentiated hepatocellular carcinoma
The aspirate is hypercellular with multilayering, mild nuclear atypia with anisokaryosis, proeminent nucleoli, occasional intranuclear inclusions and eosinophilic, finely granular cytoplasm. Some of the tissue fragments are transversed by spindle-shaped endothelial cells. Thickened trabeculae of hepatocytes, highlighted with reticulin stain, are better seen on cell block sections. IHC revealed positivity for CEAp (canalicular pattern), Glypican (intracytoplasmic pattern) and CD34 (complex capillary network).
The overall features are consistent with the diagnosis of well differentiated hepatocellular carcinoma.