Contributed by Anthony J. Demetris, M.D.
PATIENT HISTORY: Per referral report, the patient is an elderly male with elevated alpha fetoprotein. The patient was admitted to the hospital following outpatient workup which revealed the presence of a right proximal, third clavicular, lytic lesion in his bone and also a probable hepatic metastasis. This elderly male presented with some ecchymosis of the right clavicle about five weeks ago. X-ray revealed the presence of lytic lesion. Following this out patient workup was continued to include lab work, CT scan of the chest, abdomen and pelvis. These workups failed to reveal any significant primary tumor. However, there was evidence of probably metastatic infiltration of the liver. The patient has a positive history of having COPD in the past. He still smokes one half to one pack of cigarettes per day. He was a former drinker. He has been drinking some wine lately but not very much according to his daughter, may an occasional glass with Sunday dinner and other than that, he has abstained totally from alcohol. His current medical regimen includes Glucotrol 5 mg po daily; Lasix 40 mg daily and Aldactone 25 mg bid. He has allergies to Penicillin. R/O hepatoma/liver metastasis. Review of outside material.

Final Diagnosis (Case 36)


Previous Biopsies on this Patient:

TPIS Related Resources:
National Cancer Institute PDQ treatment information on liver cancer
Liver Transplant Topics

Gross Description - Case 36

The specimen consists of one (1) consult slide and one (1) paraffin block with an accompanying surgical pathology report.

Microscopic Description - Case 36

The specimen consists of multiple fragmented needle cores of liver. No normal hepatic architecture is identified. Instead, the tissue consists of a few areas of fibrous septae containing bile ducts and other fibrous tracts intermixed with hepatocytes growing in a macrotrabecular growth pattern. No normal sinusoidal architecture is identified. Instead, the trabeculae are greater than five to six cell layers thick in some areas. In addition, there are aberrant vessels intermixed within the hepatocytes. Cytologically, the neoplastic cells contain an increased nuclear:cytoplasmic ratio, an irregular nuclear membrane, prominent eosinophilic nucleoli and focal bile production is seen. Mallory's-like hyaline is also focally present.

Overall, the histopathological changes are most consistent with a well differentiated hepatocellular carcinoma. This contention is based on the overall architectural pattern of growth, combined with the presence of "aberrant" vessels and cytological characteristics of the cells.

Finally, most of the needle core consists of neoplastic tissue and the limited remaining hepatic parenchyma is inadequate to definitively assess for the presence of underlying liver disease. However, the focal fibrosis is suggestive of chronic liver injury and fibrosis.

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