28
Liver and Pancreas
Fig. 28.22 Cholestasis in large bile duct obstruction. Bile plugs in
dilated canaculi between hepatocytes. FNA smear (Papanicolaou x OI).
Fig. 28.23 Focal nodular hyperplasia of the liver. Parallel rows
of fibrocytes that traverse a fragment of liver parenchyma. FNA smear
(Papanicolaou x LP).
Liver Cell Adenoma
Liver cell adenom as m a in ly occur in w o m e n w h o have been
taking oral contraceptives fo r long er th an 5 years. Liver cell ade-
n o m a m ay disappear fo llo w in g cessation o f oral contraceptive.31
T he adenom as are u su ally so lita ry (7 0 -8 0 % ), b u t 10% o f cases
are m u ltip le.28 Liver cell adenom a m ay rupture, leading to
p eritoneal hem orrhage. CT scan shows a circum scribed, som e-
tim es encapsulated, o fte n subcapsular mass w ith lo w density
o n noncontrast and a m arked centripetal pattern o f enhance-
m e n t on arterial phase. The lesio n can have a central necrotic
area o r calcifications. O n histology, the tu m o rs are com posed o f
liv e r parenchym a w ith o u t p ortal triads o r b ile ducts. The tu m o r
contains abund ant sm a ll arteries, and areas o f hem orrhage
and necrosis are o fte n present.
Fig. 28.24 Focal nodular hyperplasia of the liver. Parallel rows of
fibrocytes that traverse benign hepatocytes, e.g. abundant cytoplasm and
with no nuclear atypia. FNA smear (Papanicolaou x HP).
Fig. 28.25 Liver cell adenoma. A large cohesive fragment that contains
normal-appearing hepatocytes with uniform, round nuclei. Radiology
correlation is crucial. FNA smear (Papanicolaou x LP).
Cytology
The gross appearance o f the aspirates is rig id cores o f tissue d iffic u lt
to sm ear (Fig. 28.25),25 as the result o f n o rm a l o r slig h tly reduced
retic ulum fibers.26 FN A smears contain num erous closely packed,
three-d im ensional groupings o f hepatocytes. The cytoplasm o f
these liv e r cells is fre q ue ntly rather pale because o f increased gly-
cogen deposition. N o b ile duct e p ithelial cells o r fibroblasts are
present. The m on o to n o u s p o p u la tio n o f hepatocytes is n o rm a l-
lo o kin g (Fig. 28.26) . M itoses are n o t seen. Necrotic hepatocytes
m ay be noted. The cytologic finding s are n o t diagnostic o f live r
cell adenom a on p urely cytom orp holog ic grounds. However, if
the aspirator is certain th a t the sam ple derives fro m a nod ule
w ith radiologic features com patible w ith liv e r cell adenom a, and
needle tip p o sitio n has been checked b y an im aging technique,
883
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