Fibrolamellar hepatocellular carcinoma: A case report with cytological features in a sixteen-year-old girl

Abstract

We report a case of a 16-yr-old girl with a liver tumor revealed by thrombophlebitis of the left leg. On physical examination the patient was found to have painless hepatomegaly. Ultrasound and CAT scan showed a large tumor of the left portion of the liver, measuring 14 cm in diameter. Cytological preparations were touch imprints of the biopsy fragments obtained under ultrasound guidance. Cytological examination using May-Grünwald Giemsa stain revealed highly cellular smears containing large tumor cells with a round nucleus, prominent nucleoli, and abundant granular basophilic cytoplasm. Cytological features were those of fibrolamellar hepatocellular carcinoma, confirmed by histological examination of the biopsy sample as well as the surgical specimen obtained after wide excision of the lesion following ineffective neoadjuvant chemotherapy.

Diagnosis of metastatic fibrolamellar hepatocellular carcinoma by endoscopic ultrasound-guided fine needle aspiration

“…[9] Intracytoplasmic hyaline globules (thought to be large lysosomes)[9] and intracellular bile pigment may be seen. [57] Intranuclear pseudoinclusions may be present and binucleation is not uncommon. [47] Bland, spindled cells arranged in parallel bands may also be seen, representing the bundles of collagen fibers and fibroblasts seen in the histologic sections.…”

“…Other unusual tumors may also include metastatic carcinoma with prominent fibrosis and metastatic melanoma. [1356] This FNA, however, was not obtained from the primary lesion but, instead, represented a mediastinal lesion.…”

Detection of Metastatic Fibro-Lamellar Type of Hepato Cellular Carcinoma in Ascitic Fluid Cytology in a Liquid-Based Preparation

“…6 Intra cytoplasmic hyaline globules and bile can also be present. 5 Bland, spindle shaped cells arranged in parallel bands may also be noted on cytology smears, representing collagen fibers and fibroblasts, which are better appreciated on histologic sections. The trabecular arrangement with transversing capillary channels of conventional HCC is not usually seen.…”

“…The trabecular arrangement with transversing capillary channels of conventional HCC is not usually seen. [4][5][6] Some times, FL-HCC may be difficult to differentiate from conventional HCC. As compared to conventional HCC, the smears in the present case did not reveal the "basketing" pattern" or traversing capillaries that are commonly seen in conventional HCC.…”

“…[4][5] Detection of this uncommon variant of HCC on exfoliative cytology poses diagnostic challenges to cyto pathologists, especially when there is no clinical suspicion or clinical details are not known at the time of reporting. We present a unique case of metastatic FL-HCC detected on ascitic fluid cytology and ultrasound-guided fine needle aspiration (US-FNA) of retroperitoneal lymph node.…”