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HK Society of Cytology Seminar Workshop, 22 June 2002 FNA OF LIVER Diagnostic problems

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HK Society of Cytology Seminar Workshop, 22 June 2002 FNA OF LIVER Diagnostic problems

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    1. HK Society of Cytology Seminar & Workshop, 22 June 2002 FNA OF LIVER Diagnostic problems

    2. Why FNA of Liver, & not Bx?

    3. FNA of Liver - Advantages Small ? screening program Safe Multiple sampling Immediate microscopic assessment Adequate specimen guaranteed Treatment simultaneously

    4. Diagnostic Problems Very well-differentiated hepatocellular lesions - benign vs malignant Poorly differentiated neoplasms - typing & primary vs metastatic Unusual tumors

    5. Clinical Information of importance Serum AFP & Hepatitis viral markers - AFP >1000 ng/ml highly suggestive of HCC - 80% HCC HBsAg+ve Presence or absence of cirrhosis - 85% HCC cirrhotic Size of lesion / Radiographic appearance - DN >2cm (in cirrhosis) mostly malignant Sex / Age

    6. Usefulness of Cell Block Does not add to the detection (if obtained during the same pass), but helpful for confirming nature and cell type Trabeculae formation and cell plate thickness Evaluate reticulin framework Identify pigments Immunohistochemistry

    12. HEPATOCELLULAR CARCINOMA Malignant features Excessive cellularity Trabeculae/cords/sheets of >3 cells in width Obvious glandular pattern Loss of cell cohesion, atypical naked nuclei Usual nuclear features of malignancy: nuclear pleomorphism, coarse chromatin, eosinophilic macronucleoli Smaller cell size with increased N/C ratio (can be large cell); nuclear crowding Cellular monomorphism Occasional large multinucleated hepatocytes Frequent mitosis

    23. FNA OF LIVER Primary Vs Metastatic Typing of Tumor

    24. HCC vs Metastatic Carcinoma Frequent site of metastasis Easy with known primary, of medium-sized and small cells Difficult when the liver mass is the only lesion Especially when poorly differentiated and of large polygonal cells

    28. HEPATOCELLULAR CARCINOMA Immuno indicating hepatocellular differentiation 1980’s AFP, A1AT 1990’s CK pattern, pCEA, ±AFP 2000’s HepPar-1, albumin mRNA, CK pattern, ± pCEA, ± AFP (serum)

    44. FNA OF LIVER UNUSUAL TUMORS

    50. Hypercellular smear Very broad and often double-cell layered sheets of biliary ductal columnar epithelium Papillary configuration Preserved honeycomb pattern with nuclear spacing Dysplasia but not frankly malignant nuclear features DDx: Adenocarcinoma, primary or metastatic Papillary adenocarcinoma Dysplastic ductal epithelium

    58. FNA of Liver Updated reviews: 1.Guy CD, Ballo MS. Fine needle aspiration biopsy of the liver. Adv Anat Pathol 1999;6:303-316 2.Tsui WMS, Cheng FY, Lee YW. Fine needle aspiration cytology of liver tumors. Annuals of Contemporary Diagnostic Pathology 1998, Volume 2, pp.79-93

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