Cytomorphology of a solitary left chest wall mass: An unusual presentation from unknown primary hepatocellular carcinoma

Khalbuss, M.I.A.C. Walid E.; Bajestani, Saeed; D’Agostino, Harry J.

doi:10.1002/dc.20459

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…More than 80% of the tumor cells were positive for cytokeratin on flow cytometry, which made the diagnosis of myeloma even less likely. While the FNAB findings of occult HCC presenting as nonhepatic masses in the parotid gland, soft tissue and orbit [20][21][22] have been previously reported, its expression of CD138 by flow and IHC has to our knowledge not been described in the cytology literature. Our case highlights the fact that while ancillary studies may be important for diagnosis, thorough clinical information, imaging studies, and a high index of suspicion are also paramount to accurate diagnosis.…”

Section: Discussionmentioning

confidence: 83%

Metastatic hepatocellular carcinoma with CD138 positivity: An unusual mimic of multiple myeloma?

Ramalingam

Adeagbo

Bollag

et al. 2008

Diagnostic Cytopathology

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CD138 is a monoclonal anti-syndecan-1 antibody that is often used to identify plasma cells in the bone marrow of patients with multiple myeloma (MM). Several carcinomas may also express CD138 including prostate, colon, renal cell, and hepatocellular carcinoma (HCC). We report a case of metastatic HCC that presented as a soft tissue mass on the back of a 67-year-old male. Based on the clinical and radiologic findings, MM was strongly suspected. In addition, fine-needle aspiration biopsy (FNAB) of the mass revealed neoplastic cells that were positive for CD138, both by immunohistochemistry (IHC) and flow cytometry. The cytomorphologic features however did not support a diagnosis of MM, but were consistent with metastatic HCC. Our case highlights the potential problems that may arise by over-reliance on IHC and flow cytometry. Careful morphologic assessment as well as clinical and radiologic correlation are very important when evaluating any CD138-positive neoplasm. This approach should improve diagnostic accuracy and reduce the risk of erroneous interpretation of aberrant IHC results. In addition, we examined the expression of CD138 in known cases of HCC.

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Section: Discussionmentioning

confidence: 83%

Metastatic hepatocellular carcinoma with CD138 positivity: An unusual mimic of multiple myeloma?

Ramalingam

Adeagbo

Bollag

et al. 2008

Diagnostic Cytopathology

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“…ROSE is helpful to communicate with the endoscopist about placement of the needle. From our literature review, while FNA of presumed ectopic liver within the thorax has been reported,[12] ours is the first report of perigastric ectopic liver diagnosed by FNA.…”

Section: Discussionmentioning

confidence: 90%

“…In addition to confirming the presence of hepatic tissue, it was also useful to exclude the possibility of hepatocellular carcinoma, which has been reported in ectopic liver. [9101112] This needle is new to the US market. One pilot study on this device currently in press was performed at our institution and showed that the device performs very well when compared to a standard EUS-FNA needle in terms of yield and reduced number of passes.…”

Section: Discussionmentioning

confidence: 99%

An unexpected diagnosis of ectopic liver diagnosed by fine needle aspiration

2016

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The differential diagnosis of perigastric masses is broad, ranging from benign to malignant entities. Among the benign entities, accessory liver lobes and ectopic liver are unusual and often incidentally discovered. Here, we report a patient with malignant melanoma who was clinically suspected to have a perigastric metastasis or a gastrointestinal stromal tumor but was ultimately diagnosed by fine needle aspiration (FNA) to have benign ectopic liver. A 47-year-old male was diagnosed with malignant melanoma of the scalp in May 2015 at a tertiary care hospital. He was found to have a 2.6 cm enhancing mass adjacent to the fundus of the stomach and below the diaphragm by computed tomography imaging. To exclude metastasis, the patient was referred to endoscopy, and an endoscopic ultrasound-guided FNA was performed with rapid on-site evaluation (ROSE) by a cytopathologist. A relatively new FNA needle (Shark Core) was used, which produced useful core biopsy material. Cytopathology demonstrated flat sheets, single cells, and small clusters of polygonal cells. There was abundant granular cytoplasm, often containing pigment. Cells lacked pleomorphism. The smear findings appeared consistent with hepatocytes. The cell block demonstrated small core fragments of hepatic parenchyma with portal tracts. Immunohistochemistry for arginase-1 confirmed that this was hepatic tissue. ROSE was useful for communicating with the endoscopist that the mass was both far from, and not connected to, the liver. This is the first documented account of perigastric ectopic liver diagnosed by FNA. This entity should be considered in the differential of perigastric masses.

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“…Literature reports seven such cases, of which one was diagnosed on cytology. [2][3][4][6][7][8][9] Most of these cases had metastatic HCC from a clinically and radiologically unrecognized liver mass. In the present case, USG revealed a lesion in the right lobe of liver.…”

Section: Discussionmentioning

confidence: 99%

“…The described case presented solely with an isolated chest wall swelling, diagnosed on FNAC. Literature reports seven such cases, of which one was diagnosed on cytology 2–4,6–9 . Most of these cases had metastatic HCC from a clinically and radiologically unrecognized liver mass.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma presenting as a chest wall mass – An unusual case diagnosed on cytology with review of literature

Agnihotri

Sathe

Singh

et al. 2023

Diagnostic Cytopathology

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Hepatocellular carcinoma (HCC) is associated with an aggressive behavior and a strong tendency for extrahepatic metastasis. Although 5%–15% patients have metastases at diagnosis, presentation with symptoms exclusively related to extrahepatic metastases is rare. An 82‐year‐old male presented with an isolated left anterolateral chest wall swelling. Ultrasonography revealed a soft tissue mass involving the anterior chest wall with adjacent rib erosion. Serum protein electrophoresis showed increase in beta‐2 region. A clinical diagnosis of multiple myeloma was considered. Fine needle aspiration cytology from the swelling showed loosely cohesive clusters of polygonal cells with traversing blood vessels. Cells showed abundant vacuolated to granular cytoplasm, round nuclei with frequent intranuclear cytoplasmic inclusions. A differential of metastatic HCC and renal cell carcinoma was considered. Subsequent imaging showed a 12 cm mass in the liver. Biopsy from chest wall mass with immunohistochemistry confirmed the diagnosis. Lungs and lymph nodes are the commonest sites for metastatic HCC; presentation as chest wall metastasis is rarely reported. The classical cytomorphology of HCC proved useful in diagnosing metastasis at a rare site. Recent studies have shown that beta‐2‐globulin is a promising biomarker for early diagnosis of HCC in patients with chronic liver disease.

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Cytomorphology of a solitary left chest wall mass: An unusual presentation from unknown primary hepatocellular carcinoma

Cited by 9 publications

References 10 publications

Metastatic hepatocellular carcinoma with CD138 positivity: An unusual mimic of multiple myeloma?

Metastatic hepatocellular carcinoma with CD138 positivity: An unusual mimic of multiple myeloma?

An unexpected diagnosis of ectopic liver diagnosed by fine needle aspiration

Hepatocellular carcinoma presenting as a chest wall mass – An unusual case diagnosed on cytology with review of literature

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