The strength of cytomorphology and efficacy of immuno-cytochemistry in distinguishing hepatocellular carcinoma from its mimics on fine-needle aspiration cytology.

BACKGROUND: Cytomorphologic distinction of hepatocellular carcinoma (HCC) from its mimics on fine-needle aspiration cytology (FNAC) is often problematic. The present study evaluates the strength of cytomorphology and the utility of an immuno-panel of arginase-1, glypican-3, HepPar-1, thyroid transcription factor (TTF-1) and CK-19 in resolving this diagnostic issue. METHODS: FNAC features of 71 nodular hepatic lesions were studied with an immunocyto/ histochemical (ICC/IHC) panel of arginase-1, glypican-3, HepPar-1, TTF-1 taking 10% positivity as "cut-off." Cytomorpholologic diagnoses were compared with diagnoses made on combined cytomorphologic and ICC/IHC approach. RESULTS: Of 71 cases, 32, 10 and 29 had histopathologic, cell block and clinico-radiologic correlation respectively with 55 metastatic adenocarcinomas (MAC), 13 HCCs and one case each of hepatic adenoma (HA), cirrhotic nodule (CN) and intrahepatic cholangiocarcinoma (CC). Cytoplasmic positivity of HepPar-1 and glypican-3 were noted in 11/13 and 8/13 HCCs respectively; while only 3/13 and 1/13 HCCs revealed cytoplasmic positivity for arginase-1 and TTF-1 respectively. Benign hepatic lesions were negative for glypican-3 and TTF-1, but expressed both arginase-1and HepPar-1. Twenty-one of 55 MACs and the lone case of CC were positive for CK-19; however, all MACs and CC cases were negative for HepPar-1, arginase-1, glypican-3 and TTF-1. The immune-panel had sensitivity, specificity and diagnostic accuracy of 100%, 88.9% and 90.6%, respectively, for differentiating HCC from its morphologic mimics. CONCLUSION: Though a meticulous cytologic evaluation in conjunction with clinicoradiologic profile helps in distinguishing HCC from its benign and malignant mimics; an immunopanel of arginase-1, glypican-3, HepPar-1, TTF-1 and CK-19 drastically improves the diagnostic accuracy.

Fine-needle aspiration cytology and cell block in diagnosis and subtyping of hepatoblastoma.

Hepatoblastoma (HB) constitutes less than 1% of all pediatric malignancies and is the most common malignant tumor of liver in children. The fine-needle aspiration cytological (FNAC) diagnosis and sub-typing of this tumor is challenging, which is of critical importance from its treatment point of view. All cases with a clinicoradiological impression of "HB" during the study period of 1 year were subjected to ultrasound-guided (USG) FNAC and cell blocks were prepared in all cases. Detailed cytopathological examination was carried out based on the cytomorphological pattern and the cell blocks were used to correlate the findings and the final diagnoses were confirmed with the histopathological findings. Four cases were included during this study period. All were children, whose age ranged from 3 months to 10 years. All of them presented with mass per abdomen and increased serum alfa-feto protein (AFP) levels. On a detailed cytological examination, the clinical impression of HB was confirmed in all four cases with a subsequent histological correlation. Based on their distinct cytomorphological pattern, three of them were accurately sub-typed as"fetal type," wile the fourth was an "embryonal type of HB." All four cases had the evidence of extramedullary hematopoeisis. We conclude that a precise preoperative FNAC diagnosis with accurate sub-typing of HB is possible purely on cytomorphologic basis which has prognostic and therapeutic implications. Cell blocks are of great use for ancillary studies. Extramedullary hematopoiesis serves as an important "clue" in diagnosis.

Proximal epithelioid sarcomatous dedifferentiation in secondary chondrosarcoma in a known case of multiple osteochondromatosis.

Osteochondroma is the most common benign bone tumor. Approximately 15% of osteochondromas occur as multiple lesions. Multiple osteochondromatosis has a higher risk of developing chondrosarcomas, which are of low grade with good prognosis. About 10% of all chondrosarcomas may undergo dedifferentiated change, which has a poorer prognosis. Dedifferentiated peripheral chondrosarcoma developing within an osteochondroma is extremely rare. Dedifferentiation usually occurs in the form of osteosarcoma, malignant fibrous histiocytoma, fibrosarcoma, or rhabdomyosarcoma. We report a case of proximal epithelioid sarcomatous dedifferentiation in secondary chondrosarcoma in a 39-year-old male with multiple osteochondromatosis in bilateral arm. To the best of our knowledge, epithelioid sarcomatous dedifferentiation has not been described in the literature.