Difference between revisions of "mgh:cyto-1-10"
From MGH Learn Pathology
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* Bile duct epithelium present (except in LCA) | * Bile duct epithelium present (except in LCA) | ||
* Core biopsies provide specific diagnosis: Reticulin stain shows retention of 1 to 2 cells thick hepatic plate framework on cellblock; unpaired arterioles in parenchyma for LCA; bile duct proliferation and scar for FNH | * Core biopsies provide specific diagnosis: Reticulin stain shows retention of 1 to 2 cells thick hepatic plate framework on cellblock; unpaired arterioles in parenchyma for LCA; bile duct proliferation and scar for FNH | ||
− | + | {{img3|1-10-1 benign_hepatocytes_and_ductal_cells.N12-12133..jpg|1-10-2 reactive_hepatocytes._N12-12133.jpg|Benign hepatocytes and ductal cells|Reactive hepatocytes}} | |
− | Benign hepatocytes and ductal cells | + | {{img3|1-10-3 reactive_hepatoctes_2.N12-133.jpg|1-10-4 benign_liver_with_reticulin_stain.N12-4918.jpg|Reactive hepatocytes|Benign liver (cirrhosis) with reticulin stain}} |
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− | Reactive hepatocytes | ||
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− | Reactive hepatocytes | ||
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− | Benign liver (cirrhosis) with reticulin stain | ||
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'''Well-differentiated Hepatocellular Carcinoma – N13-6335 and N12-5663''' | '''Well-differentiated Hepatocellular Carcinoma – N13-6335 and N12-5663''' | ||
* Under low power microscopy, smear pattern shows trails of smooth-edged, arborizing clusters of thickened trabeculae with peripheral endothelium (pathognomonic) | * Under low power microscopy, smear pattern shows trails of smooth-edged, arborizing clusters of thickened trabeculae with peripheral endothelium (pathognomonic) | ||
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* α-fetoprotein is helpful if positive but often is not | * α-fetoprotein is helpful if positive but often is not | ||
* Novel markers, such as glypican-3, glutamine synthetase and heat shock protein 70, are helpful if two out of three show positivity | * Novel markers, such as glypican-3, glutamine synthetase and heat shock protein 70, are helpful if two out of three show positivity | ||
− | + | {{img3|1-10-5 N13-6335.WDHCC.jpg|1-10-6 HCC._reticulin_staining_with_staining_of_thickened_trabeculae.N13-6335..jpg|BWell-differentiated hepatocellular carcinoma (WDHCC) with peripherally wrapping endothelial cells|WDHCC: reticulin staining showing thickened trabeculae (>3 cells)}} | |
− | + | {{img3|1-10-7 HCC._reticulin_stain_with_loss_of_staining._N13-6335.jpg|1-10-87 HCC_with_transgressing_vessels._N13-6335..jpg|WDHCC reticulin stain with loss of staining|WDHCC with transgressing, arboring vessels}} | |
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− | WDHCC: reticulin staining showing thickened trabeculae (>3 cells) | ||
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− | WDHCC reticulin stain with loss of staining | ||
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− | WDHCC with transgressing, arboring vessels | ||
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'''Moderately to Poorly Differentiated Hepatocellular Carcinoma –N12-6639, NC13-322 and N11-12944''' | '''Moderately to Poorly Differentiated Hepatocellular Carcinoma –N12-6639, NC13-322 and N11-12944''' | ||
* Low power smear pattern generally resembles that seen in well-differentiated tumors; however, there is a dyshesive tendency in poorly differentiated tumors | * Low power smear pattern generally resembles that seen in well-differentiated tumors; however, there is a dyshesive tendency in poorly differentiated tumors | ||
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* Polygonal cells with central nuclei and prominent nucleoli with visible, granular to clear cytoplasm in moderately differentiated tumors; scant to no cytoplasm with greater degree of pleomorphism and mitotic activity in poorly differentiated tumors | * Polygonal cells with central nuclei and prominent nucleoli with visible, granular to clear cytoplasm in moderately differentiated tumors; scant to no cytoplasm with greater degree of pleomorphism and mitotic activity in poorly differentiated tumors | ||
* Immunophenotype: low-molecular-weight CK (Cam 5.2), polyclonal carcinoembryonic antigen and CD10 (canalicular), and HepPar-1 and TTF-1 positive; α-fetoprotein variable; high-molecular-weight CK (AE1) negative | * Immunophenotype: low-molecular-weight CK (Cam 5.2), polyclonal carcinoembryonic antigen and CD10 (canalicular), and HepPar-1 and TTF-1 positive; α-fetoprotein variable; high-molecular-weight CK (AE1) negative | ||
− | + | {{img3|1-10-9 HG_HCC.N12-6639.jpg|1-10-10 HG._HCC.N12-6639.jpg|High grade hepatocellular carcinoma with peripherally-wrapping and arboring vascular pattern; note naked nuclei in the background|High grade hepatocellular carcinoma; note malignant cells making bile}} | |
− | High grade hepatocellular carcinoma with peripherally-wrapping and arboring vascular pattern; note naked nuclei in the background | ||
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− | High grade hepatocellular carcinoma; note malignant cells making bile | ||
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'''Metastatic colonic Adenocarcinoma -- N12-85''' | '''Metastatic colonic Adenocarcinoma -- N12-85''' | ||
* Cigar-shaped, often palisaded nuclei | * Cigar-shaped, often palisaded nuclei | ||
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* Dirty necrosis in the background (key identification point) | * Dirty necrosis in the background (key identification point) | ||
* Immunohistochemistry: CK20 positive, CK7 and CK19 negative, carcinoembryonic antigen positive | * Immunohistochemistry: CK20 positive, CK7 and CK19 negative, carcinoembryonic antigen positive | ||
− | + | {{img3|1-10-11 Met._colon_cancer.N12-85.jpg|Metastatic colonic adenocarcinoma}} | |
− | Metastatic colonic adenocarcinoma | ||
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{{:mgh:cytology-footer}} | {{:mgh:cytology-footer}} |
Revision as of 19:06, July 4, 2020
Contents
[hide]
Indications for cytology examination for liver
Procuring the specimen (liver)
Test platforms/specimen processing and triage (liver)
Reporting and terminology (liver)
Basic cytomorphology
Regenerative, Dysplastic and Benign Neoplastic Hepatocellular Nodules – N12-12133 reactive, N12-4918 and N12-6339
- Hepatocytes arranged in jagged irregular clusters, small clusters, short rows and singly (depending on regenerative, dysplastic or neoplastic nature)
- No peripheral endothelium
- Clusters rarely have transgressing endothelium (except for neoplastic aspirates)
- Reactive hepatocytes show sibling polymorphism with normal nuclear-to-cytoplasmic ratio (1/3) and frequent binucleation
- Sporadically placed large, atypical cells with mild pleomorphism of nuclear size but normal nuclear-to-cytoplasmic ratio (in dysplastic hepatocytes with large cell change)
- Small uniformly monotonous hepatocytes with increased nuclear-to-cytoplasmic ratio and nuclear crowding (in dysplastic hepatocytes with small cell change)
- Variably prominent nucleoli but no macroeosinophilic nucleoli
- Cytoplasm is generally abundant (except in small cell change) and granular but may show fatty change, lipofuscin pigment, or iron deposition
- Bile duct epithelium present (except in LCA)
- Core biopsies provide specific diagnosis: Reticulin stain shows retention of 1 to 2 cells thick hepatic plate framework on cellblock; unpaired arterioles in parenchyma for LCA; bile duct proliferation and scar for FNH
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Well-differentiated Hepatocellular Carcinoma – N13-6335 and N12-5663
- Under low power microscopy, smear pattern shows trails of smooth-edged, arborizing clusters of thickened trabeculae with peripheral endothelium (pathognomonic)
- Under low power, smear pattern shows many loosely cohesive sheets of hepatocytes with transgressing vessels (highly suspect finding)
- Monotonous, uniform hepatocytic cell population with subtle malignant features
- Pseudoacinar formation in cell clusters
- Nuclear-to-cytoplasmic ratio higher than in normal hepatocytes (>1/3)
- Macroeosinophilic nucleoli
- Reduced number of binucleated cells
- Background free of bile duct epithelial cells
- Reticulin stain demonstrates a loss of the normal 1 to 2 cells thick hepatic plate architecture
- Iron stain fails to stain tumor cells in cases of hemochromatosis
- α-fetoprotein is helpful if positive but often is not
- Novel markers, such as glypican-3, glutamine synthetase and heat shock protein 70, are helpful if two out of three show positivity
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Moderately to Poorly Differentiated Hepatocellular Carcinoma –N12-6639, NC13-322 and N11-12944
- Low power smear pattern generally resembles that seen in well-differentiated tumors; however, there is a dyshesive tendency in poorly differentiated tumors
- Peripheral endothelium is virtually pathognomonic
- Transgressing vessels are suggestive, but cannot distinguish hepatocellular from renal cell carcinoma
- Presence of intracytoplasmic bile is pathognomonic
- Polygonal cells with central nuclei and prominent nucleoli with visible, granular to clear cytoplasm in moderately differentiated tumors; scant to no cytoplasm with greater degree of pleomorphism and mitotic activity in poorly differentiated tumors
- Immunophenotype: low-molecular-weight CK (Cam 5.2), polyclonal carcinoembryonic antigen and CD10 (canalicular), and HepPar-1 and TTF-1 positive; α-fetoprotein variable; high-molecular-weight CK (AE1) negative
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Metastatic colonic Adenocarcinoma -- N12-85
- Cigar-shaped, often palisaded nuclei
- Variably prominent nucleoli, no macroeosinophilic nucleoli
- Dirty necrosis in the background (key identification point)
- Immunohistochemistry: CK20 positive, CK7 and CK19 negative, carcinoembryonic antigen positive
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