Adrenocortical carcinomas: a 12-year clinicopathologic study of 15 cases.

Adrenal cortical carcinomas are rare neoplasms and the definitive diagnostic criteria are distant metastasis and / or local invasion. Due to advances in imaging techniques, adrenal cortical neoplasms are discovered earlier and are smaller, increasing the need for more accurate diagnosis and pathologic indicators of prognosis. A twelve year retrospective clinicopathologic analysis of 15 histopathologically proven cases of adrenocortical carcinomas was done. Clinical details including radiologic findings, endocrine manifestations and gross finding were analysed. Hematoxylin and eosin stained slides were reviewed. Emphasis was on application of Weiss criteria. All fifteen tumors fulfilled Weiss criteria of malignancy, ie. all 15 possessed 3 or more of these criteria of malignancy. Functional tumors showed a greater representation of mixed cell type. It was concluded that Weiss criteria is easy to apply and that a combined evaluation of clinical features, size, weight and microscopic appearance seems necessary for the diagnosis of adrenocortical carcinomas.

Spindle cell fragments in focal nodular hyperplasia of the liver. A case report.

BACKGROUND: There are only few reports on the fine needle aspiration cytology (FNAC) findings of focal nodular hyperplasia (FNH) of the liver. CASE: A 30-year-old woman who had undergone surgery for a leiomyosarcoma of the calf, was found to have a hepatic mass five years later on imaging during routine follow-up. Fine needle aspiration was performed to rule out metastasis. Cytology revealed a few fragments of bland-looking spindle cells in a metachromatic stroma along with benign hepatocytes and bile duct cells. It was interpreted as "consistent with metastasis of leiomyosarcoma." The excised mass showed histologic features typical of FNH. CONCLUSION: Spindle cell fragments have not been previously observed in the FNAC of FNH. These fragments probably represent the muscular wall of the abnormal blood vessels of FNH. If smooth muscle fragment is seen accompanying benign hepatocytes and bile duct cells, one should consider the diagnosis of FNH in the needle aspirate.

The detection of HBV antigens and HBx-transcripts in an Indian fibrolamellar carcinoma patient: a case study.

Fibrolamellar carcinoma (FLC) of the liver is a rare variant of hepatocellular carcinoma (HCC). Here we report the case of a 12-year-old Indian male with typical FLC with no apparent hepatitis B virus (HBV) infection and a non-cirrhotic liver. The patient, though seronegative for HBsAg, showed expression of HBcAg in both the liver and tumour tissue. RT-PCR analysis revealed the presence of full-length HBx-transcripts in both liver/tumour tissue, along with truncated HBx-transcripts only in the tumour tissue. The lymphocytes in both peripheral and liver/tumour compartments showed a proliferative response to either/or HBcAg and HBxAg, which could be further augmented on addition of rIL-2. This is the first study to show not only the presence of HBcAg in the liver/tumour tissue but also prior exposure of the FLC patient's lymphocytes to HBV antigens. Also, the presence of the full-length and truncated HBx-transcripts in the tumour tissue, a proposed tumorigenic marker for hepatocarcinogenesis in chronic HBV patients, suggests an oncogenic role of HBV in this rare variant of HCC.