28
Liver and Pancreas
Fig. 28.32 Hepatocellular carcinoma, well-differentiated cell
type, classic. High power reveals monotonous population of small
hepatocytes in trabeculae that are three cells or thicker, wrapped by
sinusoidal endothelial cells. FNA smear (Papanicolaou x HP).
Fig. 28.33 Hepatocellular carcinoma, well-differentiated cell type,
microtrabecular variant. Granular smear containing fragments of narrow
trabecular groupings without sharp outline. FNA smear (Papanicolaou x LP).
e nd o the liu m . T he m icrotrabeculae are com posed o f m o n o to n o u s
sm all hepatocytes w ith sm all nucleoli. T he h isto lo g y o n cell
b loc k shows com pact o r m icrotrab ecular arrangem ent.
M icroacinar Variant19'37
T he aspirates present as granular smears c on tain in g num erous
dyscohesive rosette-like m ic roa cini (Fig. 2 8.3 5 ) com posed o f as
few as five o r six cells (Fig. 28.3 6 ) . The c ytom orp h olog y o f m ic ro -
acinar va ria n t resembles th a t o f neuroend ocrine tu m o rs at lo w -
pow er exam ination. The m ic roa cini have a central canaliculus
and peripheral nuclei. H isto lo g y on cell b loc k shows com pact or
m icroacinar arrangem ents, p ositive fo r Hepar-1 im m u n o s ta in
and negative fo r neuroend ocrine im m un om a rke rs.
C lear Cell Variant19,47
T he aspirates present as granular smears con tain in g m an y tu m o r
cells th a t have vacuolated cytoplasm in cohesive grouping. A PAS
stain w ith and w ith o u t diastase dem onstrates intracytop lasm ic
Fig. 28.34 Hepatocellular carcinoma, well-differentiated cell
type, microtrabecular variant. High power examination reveals small
hepatocytes arranged in trabeculae that are one or two cells thick, without
endothelial wrapping. FNA smear (Papanicolaou x MP).
Fig. 28.35 Hepatocellular carcinoma, well-differentiated cell
type microacinar variant. Granular smear containing numerous
rosette-like groupings mimicking neuroendocrine tumors. FNA smear
(Papanicolaou x LP).
glycogen.
Intracytop lasm ic lip id vacuoles
are also
present
in som e areas, and th e y are in d istin g uisha b le fro m vacuoles
resulting fro m glycogen. T he cytoplasm o f tu m o r cells contains
a single large, clear vacuole or, less freq uently, m u ltip le sm all
vacuoles o f variab le size. T he large vacuoles displace the nuclei
to the p erip hery o f the cells and also distend th e cells. The
tu m o r cells have ro u n d o r o vo id nuclei, c en trally o r eccentri-
cally located, and conspicuous n u c le oli, typical fo r hepatocytes
(Fig. 2 8 .3 7 ) .
Key features of hepatocellular carcinoma, well
differentiated
• P hysical features o f th e aspirate: g ra n u la r sm ear.
• M o n o to n o u s p o p u la tio n o f s m a ll hepatocytes w ith h ig h
N /C ra tio (n o rm a l nuc le ar size b u t c ytop lasm is reduced).
887
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