Contributed by Randall G. Lee, M.D.
PATIENT HISTORY: Per referral letter, the patient is a 72-year-old male with a large hepatic mass. The sonogram report indicates the mass to be 17 x 15 x 13.5 cm. and involves the left hepatic lobe. The gallbladder and biliary tract are normal, and there are bilateral renal cysts. No other clinical information is available at this time. Review of outside material.

Final Diagnosis (Case 40)

LIVER, NEEDLE BIOPSY -
  1. HEPATOCELLULAR CARCINOMA, WELL DIFFERENTIATED, WITH FOCAL CLEAR CELL DIFFERENTIATION.
  2. NO BACKGROUND LIVER PRESENT FOR EVALUATION.

Previous Biopsies on this Patient:
None

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

Gross Description - Case 40

The specimen consists of eighteen (18) consult slides and one (1) paraffin block. No surgical pathology report is received with the specimen.

Microscopic Description - Case 40

The liver biopsy demonstrates several fragments of hepatocellular carcinoma characterized by irregular trabeculae of well differentiated malignant hepatocytes with focal clear cell differentiation. Several fragments contain dense fibrosis containing hemosiderin-laden macrophages. The tumor abruptly abuts the adjacent fibrosis without any intervening ductular reaction. The reticulin stain demonstrates focal thickening of the cell plates with patchy loss of reticulin, consistent with a hepatocellular carcinoma. Immunostains show positive reaction for CAM5.2 cytokeratin, but negative for alpha-fetoprotein, AE1 cytokeratins, and monoclonal CEA, a pattern of reactivity again consistent with hepatocellular carcinoma. No background liver is present in the sections and thus no assessment of the presence of underlying cirrhosis can be made.

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