Extramedullary hematopoiesis as a ′clue′ to diagnosis of hepatoblastoma on fine needle aspiration cytology: A report of two cases

Thambi, Renu; Devi, L Purnima; Balachandran, Krishna; Poothiode, Usha

doi:10.4103/0970-9371.117643

Cited by 9 publications

(12 citation statements)

References 4 publications

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“…An acinar arrangement is prominent in the fetal areas, whereas it is not a feature in HCC. Although the presence of intranuclear cytoplasmic inclusions or bile pigment mostly favors a diagnosis of HCC, it does not completely rule out HB . Intracytoplasmic bile thus suggests a hepatocellular origin of the tumor cells only.…”

Section: Discussionmentioning

confidence: 97%

“…Intracytoplasmic bile thus suggests a hepatocellular origin of the tumor cells only. EMH with the presence of megakaryocytes favors HB, so a careful search for the same is useful . The embryonal cells of HB have a differential diagnostic implication that is very different from that of fetal cells.…”

Section: Discussionmentioning

confidence: 99%

“…Although the presence of intranuclear cytoplasmic inclusions or bile pigment mostly favors a diagnosis of HCC, it does not completely rule out HB. 20 Intracytoplasmic bile thus suggests a hepatocellular origin of the tumor cells only. EMH with the presence of megakaryocytes favors HB, so a careful search for the same is useful.…”

Section: Discussionmentioning

confidence: 99%

“…EMH with the presence of megakaryocytes favors HB, so a careful search for the same is useful. 20 The embryonal cells of HB have a differential diagnostic implication that is very different from that of fetal cells. The small round cell tumors of the pediatric age group that are the main diagnostic considerations include the following: neuroblastoma, Wilms tumor of the right kidney abutting on the…”

Section: Discussionmentioning

confidence: 99%

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Cytomorphology of hepatoblastoma with histological correlation and role of SALL4 immunocytochemistry in its diagnosis, subtyping, and prognostication

Nakra

Roy

Yadav

et al. 2019

Cancer Cytopathology

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Background Hepatoblastoma (HB) is the most common malignant pediatric liver tumor, and cytology material is often the only tissue available for evaluation before definitive therapy. Subcategorization of HB based on cytomorphological features thus carries an important role in its prognostication. Spalt‐like transcription factor 4 (SALL4), a marker of embryonic stem cells that is also found in the fetal liver, is reactivated in certain liver tumors. Limited studies have evaluated its role in HB. This study was aimed at evaluating the cytomorphological features of HB and assessing the utility of SALL4 immunocytochemistry (ICC) in its subtyping and prognostication. Methods Pretherapy fine‐needle aspiration smears from patients diagnosed with HB over a period of 9 years were retrieved. Aspirates were subclassified on the basis of the cytomorphology and were correlated with the histology wherever it was available. ICC for SALL4 was performed in 33 cases, and nuclear staining was considered positive. Results A total of 53 HB cases were included with 30 available postchemotherapy resection specimens. All the patients were diagnosed as epithelial HB on cytology, and the cases were subclassified as pure fetal (9 of 53), pure embryonal (2 of 53), or combined epithelial HB (42 of 53). There was good concordance between cytology and histology for subtyping. SALL4 immunostaining displayed strong and diffuse nuclear positivity in the embryonal component while focal and weak to negative staining in fetal cells. Conclusions Fine‐needle aspiration cytology serves as a rapid and effective tool for a correct diagnosis of HB before the implementation of chemotherapy, and SALL4 may serve as a useful diagnostic and prognostic marker.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cytomorphology of hepatoblastoma with histological correlation and role of SALL4 immunocytochemistry in its diagnosis, subtyping, and prognostication

Nakra

Roy

Yadav

et al. 2019

Cancer Cytopathology

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“…[5][6][7] FNAC is an easy, rapid, and cheap diagnostic technique for the diagnosis of EMH. EMH is associated with many diseases including chronic anemia, sickle cell disease, thalassemia, spherocytosis, hematological malignancies such as myelofibrosis, leukemias, myeloproliferative disorders, metastatic carcinomas in bone marrow and underlying malignancies.…”

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confidence: 99%

Extramedullary hematopoiesis: Clinical and cytological features

Kapatia

Kaur

Rastogi

et al. 2019

Diagnostic Cytopathology

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Introduction: Hematopoiesis usually occurs in bone marrow in adults and when it occurs at sites except for bone marrow, it is termed as extramedullary hematopoiesis (EMH). It is usually found in organs, which are vigorously involved in fetal hematopoiesis, including liver, spleen, and lymph nodes. FNAC is easy and rapid method to diagnose EMH.Aim: To study the spectrum of extramedullary hematopoiesis (EMH) on fine-needle aspiration cytology (FNAC).Material and methods: A total of 10 patients who were diagnosed with EMH on FNAC were studied over a period of 5.5 years. Smears were stained with May Grunwald Giemsa (MGG) and Hematoxylin and Eosin (H and E). The detailed clinical and cytomorphological spectrum of EMH were studied.Results: The mean age of the patient was 42.5 years, with age ranging between 14 and 78 years. The commonest site of EMH was lymph node (n = 8, 80%) followed by paravertebral area (n = 2, 20%). Clinical diagnosis was EMH in just one case. Mean hemoglobin of the patient was 7.9 g/L. Bone marrow examination was available in 6 cases. On FNAC, we saw variable mixture of bone marrow elements including megakaryocytes (2.6%, 0-6%), myelocytes and metamyelocytes (29.2%, 18-33%), erythroid precursors (3.2%, 0-7%), polymorphs (21.7%, 10-36%), blasts (1.1%, 0-4%), eosinophils (2.5%, 0-7%), and lymphocytes (39.7%, 21-60%).Conclusion: Cytopathologists must be alert of the clinical as well as cytological spectrum of extramedullary hematopoiesis for greater accuracy in diagnosis and to escape pitfalls in its diagnosis. K E Y W O R D Scytology, extramedullary hematopoiesis, fine-needle aspiration cytology

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