Contributed by Anthony J. Demetris, M.D.
Per referral letter, the patient is a 79-year-old male with cardiovascular problems who is on Coumadin. He was hospitalized for bleeding, and an abdominal scan revealed a hepatic mass in the left lobe. He subsequently underwent a partial hepatectomy. Grossly, there was a 7.0 x 7.0 x 6.0 cm. well-circumscribed mass in the left lobe at the free edge with a hepatoma. The cut surface confirmed the mass to be the source of bleeding. The mass was homogenous, fleshy with dilated vessels. The adjacent liver did not show any cirrhosis. AFP is within the normal range. He has no known history of anabolic steroid use or any other hormonal treatment. His hepatitis status is unknown. Review of outside material.

Final Diagnosis (Case 53)]


Previous Biopsies on this Patient:

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

Gross Description - Case 53

The specimen consists of six (6) consult slides. No surgical pathology report was received with the specimen.

Microscopic Description - Case 53

(5 H&E, 1 Reticulin) Sections from the liver show an intact lobular architecture with mild intralobular regenerative changes. Near the grossly identified mass, portal changes, typical of a mass effect, are seen.

The most significant finding is the presence of a large hepatocellular neoplasm. It appears to be largely surrounded by a fibrous capsule and/or fibrous tissue. No definite vascular invasion is seen. However, the lesion is highly cellular and contains multiple "aberrant" arteries. It is composed of small hepatocytes and abundant bile production with pseudoacinar formation can be seen. Cytologically, many of the small hepatocytes comprising the lesion are quite small and some contain eosinophilic globules. For the most part, they also contain small a small round nucleus and a small amount of eosinophilic cytoplasm. The N:C ratio is increased in some areas throughout the tumor. In addition, focal clear change is seen.

On closer examination, an increased mitotic rate is seen in some areas up to 1/2-3 HPF. Individual apoptotic tumor cells are also seen.

The reticulin stain nicely demonstrates focal paucity of reticulin fibers in between individual clusters and sheets of the neoplastic cells. This is in contrast to the intact reticulin architecture in the surrounding liver.

Overall, I feel these findings are indicative of a well- differentiated hepatocellular carcinoma. This contention is based on the age and sex of the patient and the histopathological findings. The histologic findings in favor of a malignant diagnosis include the cellularity of the lesion, the increased mitotic rate, and focal attenuation of the reticulin architecture. I have taken the liberty of sharing this case with Drs. Nalesnik and Lee, who also concur with this diagnosis.

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