Hepatocellular carcinoma - fat containing

Case contributed by Paul Simkin
Diagnosis certain


Deranged LFTs. Liver lesion found.

Patient Data

Age: 80 years
Gender: Male

Large segment 7 lesion, with central T2 hyperintense scar. Loss of signal on out-of-phase T1 indicates intralesional fat. The liver surface is subtly irregular, indicating cirrhosis. This is supported by splenomegaly.

Multiphase CT demonstrates arterial enhancement and washout of the non-fat containing portion of the lesion, best appreciated superomedially. This is consistent with HCC.

Case Discussion

CLINICAL NOTES: R liver lobe lesion -> core Bx

MACROSCOPIC DESCRIPTION: "Liver lesion core biopsy": Three mahogany-yellow and semitranslucent core biopsies 16mm, 15mm and Ilmm. A1.

MICROSCOPIC DESCRIPTION: Sections show fragments of abnormal liver with broad tracts of fibrous tissue containing a few bile ducts. Some of the tissue lacks portal tracts and is composed of trabeculae, nests and acini of hepatocytes in plates up to 4 cells thick. The cells are enlarged with hyperchromatic and mildly pleomorphic nuclei, and large amounts of vacuolated eosinophilic cytoplasm. No mitoses are seen. There is a patchy infiltrate of lymphocytes and histiocytes and patchy pericellular fibrosis. In immunostains, the atypical cells are negative for AEI/AE3, CK7 and CK20. CD34 shows prominent and widespread endothelialisation of canaliculi. Two pieces of tissue contain three portal tracts, each with a bile ductile, but no central veins. The portal tracts are expanded by fibrosis and an infiltrate of lymphocytes, histiocytes, and occasional neutrophils. There is minimal interface inflammation. The hepatocyte plates are 1-2 cells thick. There is a patchy light lymphocytic infiltrate, particularly within the sinusoids. There are no hepatitis B cytoplasmic viral inclusions, no increase in iron, and no increase in copper associated protein. CD34 shows very little sinusoidal staining. The appearances are suspicious for a well differentiated hepatocellular neoplasm with architecture favoring a carcinoma, rather than a macroregenerative nodule. The broad bands of fibrous tissue are suggestive of cirrhosis, but the features are not diagnostic.

DIAGNOSIS: Liver lesion core biopsy: Areas of architecturally abnormal liver with features favoring a well differentiated hepatocellular carcinoma, and broad bands of fibrous tissue in keeping with cirrhosis.

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