PART TWO
Diagnostic Cytology
Fig. 28.5 Epithelial cells from a large, septal bile duct. Tall columnar
ductal epithelial cells that have ovoid nuclei with indistinct nucleoli, in a
palisading arrangement. FNA smear (Papanicolaou x HP).
Fig. 28.6 Sinusoidal endothelial cells. Sinusoidal endothelial cells
that have spindle-shaped nuclei and small amounts of cytoplasm
lining a cohesive grouping of malignant hepatocytes. FNA smear
(Papanicolaou x HP).
Fig. 28.7 Kupffer cells. A Kupffer cell that has ovoid or elongated
nuclei and scanty cytoplasm. Note that they are attached to hepatocytes.
FNA smear (Papanicolaou x HP).
Cytology
The flu id aspirated fro m a hyd atid cyst is u su ally clear and con-
tains debris, a few in fla m m a to ry cells, and num erous scoleces.
In o ld cysts, the aspirate yields large fragm ents o f lam in ated
layer (Fig. 2 8 .8 ) 17 o f the cyst w a ll in a d irty background w ith
debris c ontaining detached h ooklets and calcareous corpuscles
(Fig. 28.9). The scoleces (Fig. 28.10) m ay be d iffic u lt to fin d in FNA
smears, b u t the hooklets in a ring -like arrangem ent o r scattered
in the debris o fte n rem ain. T he fin d in g o f h ooklets o r lam in ated
layer o f the cyst w a ll is diagnostic o f hyd atid disease.
Key features of hydatid liver cyst
• C T scan: cystic mass.
• D ir ty b a ckg rou nd c o n ta in in g fra g m e nts o f la m in a te d w a ll,
debris em bedded w ith h o o kle ts , and calcareous b od ies at
lo w p o w er.
• Scolex w ith h o o k le ts seen a t h ig h pow er.
Clonorchiasis
The liv e r fluke
Clonorchis sinensis
is fo u n d in the Far East, and
clonorchiasis is encountered o n ly in im m ig ra nts in N o rth
Am erica. Patients contract the in fe c tio n b y ingesting im p ro p -
erly cooked fish con tain in g im m a tu re w o rm s (metacercaria).
C lonorchiasis m ay cause clinical sym ptom s several years after
a p atient has le ft an endem ic area. The parasites m ature in the
upper inte stina l tract and th e n invade the b ilia ry tree and the
liver. They induce a localized in fla m m a to ry reaction and hyper-
plasia o f the b ile duct e p ith e liu m th a t m ay eventually cause b il-
iary o b struction and rarely cause cholangiocarcinom a. The ad ult
w o rm s reach 2 cm in leng th and produce eggs in the b ile ducts.
Cytology
The cytologic diagnosis is based on fin d in g ova in FN A prepara-
tio n s fro m the lesions. O th e r cytologic finding s includ e abun-
d ant m ixed in fla m m a to ry cells and b ile duct e p ith elial cells th a t
often show atypia. A large n um b er o f e osinop hils and C h arc ot-
Leyden crystals m ay be seen. In
Clonorchis-induced
cholang i-
ocarcinom a, the cytologic find ing s are essentially the same as
those in o th e r cholangiocarcinom as and are discussed later (see
Cholangiocarcinoma).
Amebic Abscess
A m ebic abscesses are a result o f amebic infe ctio n caused by
Entamoeba histolytica
protozoa. In about 40% o f cases o f amebic
colitis, the p rotozoa enter the c ircu lation and are filtere d in the
liver, producing s o lita ry o r m u ltip le abscesses. The abscesses m ay
vary greatly in size and are o fte n located in the superoposterior
p o rtio n o f the rig h t lobe. The abscess cavity is fille d w ith a
chocolate-colored pasty m aterial.
Cytology
Fine-needle asp iration preparations contain ab und ant necrotic
cellular debris, degenerating hepatocytes, and m ixed in fla m m a -
to ry cells. Am ebae can be fo u n d o n ly in the m aterial aspirated
fro m the w a ll o f the abscess. The necrotic m aterial aspirated
fro m the abscess is always negative fo r parasites. In one o f o u r
patients w ith an am ebic abscess o f the liver, the aspirate was
negative fo r parasites b u t amebae were noted in her cervicovagi-
nal smear. P rotozoa in cytology preparations, i f any, are read ily
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