PMC3931243_01
Heterogenous ill-defined soft-tissue attenuation mass involving the pancreatic head and uncinate process (a) with multiple liver metastases (b) incidentally noted one of the large relatively defined mass in segment 7 of the liver is showing subtle arterial phase enhancement (c) and washout in portal venous phase (d) likely hepatocellular carcinoma
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F1
A triple phase contrast enhanced computed tomography (CT) scan of the abdomen revealed 3.5 cm x 3.2 cm x 4.0 cm hypo-enhancing mass in the pancreatic head with upstream extrahepatic and bilobar intrahepatic biliary radicles dilatation [Figure 1a], multiple small peripancreatic and mesenteric nodes. Liver showed multiple nodular lesions (metastasis) of varying sizes with differential characteristics [Figure 1b], one of the large relatively defined mass in segment 7 of the liver is showing subtle arterial phase enhancement [Figure 1c] and washout in portal venous phase [Figure 1d] likely HCC.
Fine-needle aspiration from the enhancing liver lesion. (a) Cellular smear with thickened trabeculae (Geimsa stain, x100) (b) thickened trabeculae with vascular transgression, partial endothelial wrapping, bile stasis and malignant nuclear features of hepatocytes (H and E, x200) (c) cell block preparation showing malignant hepatocytes with bile stasis (H and E, x200) (d) cell block preparation with glypican 3 positivity (x200)
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F2
The atypical hepatocytes show enlarged, hyperchromatic, markedly pleomorphic nuclei with irregular distribution of nuclear chromatin, prominent eosinophilic nucleoli, focal nuclear vacuolization and abundant granular eosinophilic cytoplasm with cholestasis [Figure 2a-c]. On immunohistochemistry-Tumor cells was positive for glypican 3 and hepatocyte specific antigen [Figure 2d].
(a) Fine-needle aspiration from other liver lesion showing metastatic adenocarcinoma (large arrow) closely admixed with benign hepatocytes (small arrow) (Geimsa stain, x200) (b) FNA from pancreatic head mass showing adenocarcinoma (Geimsa stain, x200)
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F3
These atypical epithelial cells show enlarged, hyperchromatic, markedly pleomorphic nuclei with high N:C ratio, irregular nuclear membrane, coarse chromatin and scanty cytoplasm suggestive of metastatic adenocarcinoma [Figure 3a]. These atypical epithelial cells show enlarged, hyperchromatic, markedly pleomorphic nuclei with high N:C ratio, irregular nuclear membrane, coarse chromatin and a fair amount of vacuolated cytoplasm suggestive of adenocarcinoma [Figure 3b].