PART TWO
Diagnostic Cytology
Fig. 28.36 Hepatocellular carcinoma, well-differentiated cell type,
microacinar variant. High magnification reveals the rosette-like groupings
are actually microacini, composed of small hepatocytes. Note the round
nuclei with distinct nucleolus, typical for hepatocytes, and wrong for
neuroendocrine cells. FNA smear (Papanicolaou x HP).
Fig. 28.38 Hepatocellular carcinoma, moderately-differentiated cell
type. Granular smear containing numerous naked nuclei and rare intact
tissue fragments. FNA smear (Papanicolaou x MP).
Fig. 28.37 Hepatocellular carcinoma, well-differentiated cell type,
clear cell variant. Granular smear containing single cells distended by
fat. The nuclear features are typical for hepatocytes, with round nuclei and
distinct nucleoli. FNA smear (Papanicolaou x HP).
Fig. 28.39 Hepatocellular carcinoma, moderately differentiated cell
type. High magnification shows that the intact epithelial fragments are
hepatocytes containing identical nuclei as numerous naked nuclei in the
background. FNA smear (Papanicolaou x HP).
• T h e s m a ll h e p a to c yte s m a y be arra ng e d in e n d o th e li-
u m -w ra p p e d tra b e c u la e o f th re e cells o r th ic k e r (classic
ty p e ).
• T he s m a ll hepatocytes m a y be arranged in n aked trab ecu-
lae o f o ne o r tw o cells (m ic ro tra b e c u la r typ e).
• T he s m a ll hepatocytes m a y be arranged in n aked rosette-
lik e m ic ro a c in i (m ic ro a c in a r typ e ).
M oderately D ifferentiated Cell Type19
T his type is characterized b y the fra g ility o f the cell m em brane
o f neoplastic hepatocytes, w h ic h w o u ld b urst d u ring sm earing,
resulting in num erous naked nuclei in the sm ear (Fig. 2 8.3 8 ).
T he naked nuclei are ro u n d w ith a p ro m in e n t nucleolus and are
identical to the atypical nuclei o f inta ct neoplastic hepatocytes
th a t survive the sm earing (Fig. 2 8.3 9 ) . H isto lo g y o n cell b lock
m ay show trabecular o r pseudoglandular arrangem ent. In som e
cases, the nuclear pseudoinclusions are conspicuous. In o the r
cases, rin g -fo rm nuclei are present. T he diagnosis o f m od erately
d ifferentiated cell type is straightforw ard, because the atypical
naked nuclei are evidence fo r m alig nancy and th e intact tu m o r
cells th a t survive the sm earing lo o k lik e hepatocytes.
Key features of hepatocellular carcinoma, moderately
differentiated
• P hysical features o f th e aspirate: g ra n u la r sm ear.
• A b n o rm a lly fra g ile hepatocytes, e asily ru p tu re d b y
sm e aring .
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