A case of bone metastasis of hepatocellular carcinoma: Mallory hyaline bodies can lead to the correct cytological diagnosis

Abstract

Hepatocellular carcinoma (HCC) accounts for most primary tumors of the liver.Although bone metastasis does not occur in a high percentage of patients, bone metastasis is often found first, which leads to the diagnosis of HCC. In this report, we describe a case of bone metastasis from HCC in which bone lesions were detected incidentally, and in which a cytological diagnosis was difficult to make. The patient was a 78-year-old man with a history of renal dysfunction after orthopedic surgery.He underwent a thorough examination after a bone tumor was incidentally found on abdominal CT. Plasmacytoma was suspected. Fine needle aspiration cytology revealed irregular clusters of medium-to-large atypical epithelioid polygonal cells with relatively abundant eosinophilic, somewhat granular cytoplasm, and indistinct cell borders, which led to a diagnosis of malignancy. Histologically and immunohistochemically, the tumor was diagnosed as bone metastasis of HCC. Re-examination of the cytological specimen revealed characteristic Mallory hyaline bodies (MHBs).Immunohistochemistry using a cell transfer method revealed that they were positive for low molecular weight cytokeratin, Cam5.2, in a densely granular fashion. In this case, the cytological diagnosis of HCC was difficult to make due to the unclear cytoplasmic borders and absence of bile pigment. However, the identification of MHBs can potentially guide me to the correct cytological diagnosis.

A Unique Surgical Case of Mixed Metaplastic Breast Carcinoma With Heterologous Mesenchymal Differentiation and Conventional Adenocarcinomatous Elements

“…Those cytologic features are considered to reveal complete absence of highly atypical epithelial-like cells forming cohesive sheet-like and "three-dimensional" clusters [4]. Furthermore, the findings of the current immunohistochemical analyses suggest that immunostaining for specific epithelial markers, such as EMA, on sarcomatoid elements in cytological smears (i.e., immunocytochemistry) must be useful for the differential diagnosis with malignant phyllodes tumor or primary breast sarcomas [7][8][9].…”

A case of lymphomatous pleural effusion from angioimmunoblastic T‐cell lymphoma: The methodology of cell transfer technique and immunocytochemistry on an inadequate cytology specimen can potentially guide us to the correct diagnosis

“…3 In addition, when submitted effusion is sufficiently available for various examinations, clinicians/cytopathologists should perform not only immunohistochemistry but flow cytometry or next-generation sequencing studies. 7 In fact, flow cytometry can also play a key role for confirmation of the final diagnosis of AITL effusion, after ruling out the differential diagnoses (including B-cell lymphoma, Hodgkin lymphoma, natural killer lymphoma, other T-cell lymphomas, poorly differentiated carcinoma, or malignant melanoma). Nevertheless, because of the insufficient/inadequate amount of submitted pleural effusion in the current case, only 10 mL, we were never able to make cell block sections or perform additional immunocytochemistry.…”

“…The expressions of follicular helper T‐cell markers, including PD‐1, CD10, bcl‐6 or CXCL‐13, are very useful for the definitive diagnosis of lymphomatous effusion caused by AITL, according to the first case report diagnosed by cell block immunohistochemistry 3 . In addition, when submitted effusion is sufficiently available for various examinations, clinicians/cytopathologists should perform not only immunohistochemistry but flow cytometry or next‐generation sequencing studies 7 . In fact, flow cytometry can also play a key role for confirmation of the final diagnosis of AITL effusion, after ruling out the differential diagnoses (including B‐cell lymphoma, Hodgkin lymphoma, natural killer lymphoma, other T‐cell lymphomas, poorly differentiated carcinoma, or malignant melanoma).…”

“…We performed a careful cytological and immunocytochemical re‐examination with regard to the atypical immature enlarged lymphoid cells. By using a cell transfer method, 7 the atypical large, round to ovoid lymphocytes were specifically immunopositive for CD3 and CD5 (Figure 1C,D). Additional immunocytochemistry was not performed due to the insufficient/inadequate amount of submitted specimen.…”