Hepatocellular carcinoma - Revision history

Michael: tweak

2024-10-11T14:12:54Z

tweak

← Older revision		Revision as of 14:12, 11 October 2024
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	Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)		Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)
	</gallery>		</gallery>
	A
	[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		====Set 1====
	B		<gallery>
	[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:1 HCC 3 680x512px.tif\|A. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	C		File:2 HCC 3 680x512px.tif\|B. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:3 HCC 3 680x512px.tif\|C. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	D		File:4 HCC 3 680x512px.tif\|D. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:5 HCC 3 680x512px.tif\|E. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	E		File:6 HCC 3 680x512px.tif\|F. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:7 HCC 3 680x512px.tif\|G. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	F		File:8 HCC 3 680x512px.tif\|H. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		</gallery>
	G
	[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	H
	[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]

	Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments. A. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows]. B. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow]. C. The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei. D. Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion. E. The regenerative focus shows abundant cytoplasm. F. Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines. G. This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis. H. Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).		Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments. A. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows]. B. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow]. C. The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei. D. Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion. E. The regenerative focus shows abundant cytoplasm. F. Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines. G. This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis. H. Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

	A
	~~[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]~~
	B
	~~[[File:2 hcc 1 680x512px.tif\|The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).]]~~
	C
	~~[[File:3 hcc 1 680x512px.tif\|The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).]]~~
	D
	[[File:4 hcc 1 680x512px.tif\|Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).]]

			====Set 2====
			<gallery>
			File:1 hcc 1 680x512px.tif\|A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).
			File:2 hcc 1 680x512px.tif\|B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).
			File:3 hcc 1 680x512px.tif\|C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).
			File:4 hcc 1 680x512px.tif\|D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).
			</gallery>
	Hepatocellular carcinoma with acini. A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma. B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi. C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow]. D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor.		Hepatocellular carcinoma with acini. A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma. B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi. C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow]. D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor.

	A		====Set 3====
	[[File:1 steatohep HCC 6 680x512px.tif\|Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).]]		<gallery>
	B		File:1 steatohep HCC 6 680x512px.tif\|A. Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).
	[[File:2 steatohep HCC 6 680x512px.tif\|Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).]]		File:2 steatohep HCC 6 680x512px.tif\|B. Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).
	C		File:3 steatohep HCC 6 680x512px.tif\|C. Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).
	[[File:3 steatohep HCC 6 680x512px.tif\|Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).]]		File:4 steatohep HCC 6 680x512px.tif\|D. Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).
	D		</gallery>
	[[File:4 steatohep HCC 6 680x512px.tif\|Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).]]

	Hepatocellular carcinoma, steatohepatitic variant. A. Fragments of tumor at low power mimic normal hepatocyte groups without portal triads. B. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows]. D. Chronic inflammatory cells bound some cancer cells. D. Nuclear inclusions [arrows] are occasionally prominent [arrows].		Hepatocellular carcinoma, steatohepatitic variant. A. Fragments of tumor at low power mimic normal hepatocyte groups without portal triads. B. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows]. D. Chronic inflammatory cells bound some cancer cells. D. Nuclear inclusions [arrows] are occasionally prominent [arrows].

	[[File: HCC CL 1 sl 1.png\| Hepatocellular carcinoma, clear cell variant]]		====Set 4====
	[[File: HCC CL 1 sl 2.png\| Hepatocellular carcinoma, clear cell variant]]		<gallery>
	[[File: HCC CL 1 sl 3.png\| Hepatocellular carcinoma, clear cell variant]]		File: HCC CL 1 sl 1.png\| Hepatocellular carcinoma, clear cell variant
	[[File: HCC CL 1 sl 4.png\| Hepatocellular carcinoma, clear cell variant]]		File: HCC CL 1 sl 2.png\| Hepatocellular carcinoma, clear cell variant
	[[File: HCC CL 1 sl 5.png\| Hepatocellular carcinoma, clear cell variant]]		File: HCC CL 1 sl 3.png\| Hepatocellular carcinoma, clear cell variant
			File: HCC CL 1 sl 4.png\| Hepatocellular carcinoma, clear cell variant
			File: HCC CL 1 sl 5.png\| Hepatocellular carcinoma, clear cell variant
			</gallery>

	Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.		Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.

	[[File:5 04760075043191 sl 1.png\| Hepatocellular carcinoma arising in cirrhosis]]		====Set 5====
	[[File:5 04760075043191 sl 2.png\| Hepatocellular carcinoma arising in cirrhosis]]		<gallery>
	[[File:5 04760075043191 sl 3.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 1.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 4.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 2.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 5.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 3.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 6.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 4.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 7.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 5.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 8.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 6.png\| Hepatocellular carcinoma arising in cirrhosis
			File:5 04760075043191 sl 7.png\| Hepatocellular carcinoma arising in cirrhosis
			File:5 04760075043191 sl 8.png\| Hepatocellular carcinoma arising in cirrhosis
			</gallery>
	Hepatocellular carcinoma superimposed on cirrhosis in a 60 year old man. A. Dark tumor, sometimes with separate cords visible at low power (black arrow), contrasts with lightly colored regenerative nodules (green arrows) within fibrotic bands. B. Regenerative nodules are separated by a band with proliferated bile ducts, whose orientation, lacking haphazard spread, bespeaks a benign process. C. Reticulin of regenerative nodule shows two cell thick cords lacking orientation, disrupted without reason, aggregated and, at left, slighely dispersed. D. Hepatocellular carcinoma shows darker cytoplasm and more nuclei per square mm than regenerative nodules. Note the many acini, also a good sign of cancer. E. Reticulin fibers have disappeared, leaving cords with 6 or more nuclei thick in places. F. PAS D stain shows benign proliferated bile ducts, whose orientation from lower left to upper right deprives the proliferation of the haphazard nature of a cholangiocarcinoma. G. PAS-D shows the cytoplasmic digestion of glycogen in a hepatocellular carcinoma, a helpful hint at times. Note the finger like cords, the mitosis (black arrow), and the occasional acinar lumens (red arrows). H. PAS D of regenerative nodule contrasts with the image of the hepatocellular carcinoma.		Hepatocellular carcinoma superimposed on cirrhosis in a 60 year old man. A. Dark tumor, sometimes with separate cords visible at low power (black arrow), contrasts with lightly colored regenerative nodules (green arrows) within fibrotic bands. B. Regenerative nodules are separated by a band with proliferated bile ducts, whose orientation, lacking haphazard spread, bespeaks a benign process. C. Reticulin of regenerative nodule shows two cell thick cords lacking orientation, disrupted without reason, aggregated and, at left, slighely dispersed. D. Hepatocellular carcinoma shows darker cytoplasm and more nuclei per square mm than regenerative nodules. Note the many acini, also a good sign of cancer. E. Reticulin fibers have disappeared, leaving cords with 6 or more nuclei thick in places. F. PAS D stain shows benign proliferated bile ducts, whose orientation from lower left to upper right deprives the proliferation of the haphazard nature of a cholangiocarcinoma. G. PAS-D shows the cytoplasmic digestion of glycogen in a hepatocellular carcinoma, a helpful hint at times. Note the finger like cords, the mitosis (black arrow), and the occasional acinar lumens (red arrows). H. PAS D of regenerative nodule contrasts with the image of the hepatocellular carcinoma.

Michael at 14:00, 11 October 2024

2024-10-11T14:00:39Z

← Older revision		Revision as of 14:00, 11 October 2024
Line 238:		Line 238:

	==Sign out==		==Sign out==
			===Without background cirrhosis===
			<pre>
			Liver Mass, Core Biopsy:
			- HEPATOCELLULAR CARCINOMA, moderately differentiated, see comment.

			Comment:
			The liver parenchyma has architectural changes. A reticulin stain shows a thickened liver plate. A CD34 abnormally marks the sinusoids. A trichrome stain shows minimal fibrous tissue. A HepPar-1 marks the liver tissue. A CK19 and AFP are NEGATIVE.
			</pre>

	===Negative core biopsy===		===Negative core biopsy===
	<pre>		<pre>

Michael at 14:51, 16 February 2017

2017-02-16T14:51:09Z

← Older revision		Revision as of 14:51, 16 February 2017
Line 8:		Line 8:
	\| LMDDx = [[cholangiocarcinoma]], occasionally [[liver metastasis]], [[High-grade hepatocellular dysplasia\|high-grade dysplasia]]		\| LMDDx = [[cholangiocarcinoma]], occasionally [[liver metastasis]], [[High-grade hepatocellular dysplasia\|high-grade dysplasia]]
	\| Stains = reticulin (thickened liver plate)		\| Stains = reticulin (thickened liver plate)
	\| IHC = CD34 +ve sinusoids, HepPar-1 +ve (usu.), [[AFP]] +ve (usu.), CK8/18 +ve, glypican-3 +ve		\| IHC = CD34 +ve sinusoids, HepPar-1 +ve (usu.), [[AFP]] +ve (usu.), CK8/18 +ve, [[glypican-3]] +ve
	\| EM =		\| EM =
	\| Molecular =		\| Molecular =

Michael: /* IHC */

2017-02-16T14:50:48Z

IHC

← Older revision		Revision as of 14:50, 16 February 2017
Line 226:		Line 226:
	*[[AFP]] +ve; may be neg. even if the serum AFP is elevated.		*[[AFP]] +ve; may be neg. even if the serum AFP is elevated.
	*CK8/18 +ve.<ref name=pmid16680226>{{Cite journal \| last1 = Stroescu \| first1 = C. \| last2 = Herlea \| first2 = V. \| last3 = Dragnea \| first3 = A. \| last4 = Popescu \| first4 = I. \| title = The diagnostic value of cytokeratins and carcinoembryonic antigen immunostaining in differentiating hepatocellular carcinomas from intrahepatic cholangiocarcinomas. \| journal = J Gastrointestin Liver Dis \| volume = 15 \| issue = 1 \| pages = 9-14 \| month = Mar \| year = 2006 \| doi = \| PMID = 16680226 }}</ref>		*CK8/18 +ve.<ref name=pmid16680226>{{Cite journal \| last1 = Stroescu \| first1 = C. \| last2 = Herlea \| first2 = V. \| last3 = Dragnea \| first3 = A. \| last4 = Popescu \| first4 = I. \| title = The diagnostic value of cytokeratins and carcinoembryonic antigen immunostaining in differentiating hepatocellular carcinomas from intrahepatic cholangiocarcinomas. \| journal = J Gastrointestin Liver Dis \| volume = 15 \| issue = 1 \| pages = 9-14 \| month = Mar \| year = 2006 \| doi = \| PMID = 16680226 }}</ref>
	*Glypican-3 +ve (cytoplasmic, granular cytoplasmic or membranous).<ref name=pmid19212669>{{Cite journal \| last1 = Shirakawa \| first1 = H. \| last2 = Kuronuma \| first2 = T. \| last3 = Nishimura \| first3 = Y. \| last4 = Hasebe \| first4 = T. \| last5 = Nakano \| first5 = M. \| last6 = Gotohda \| first6 = N. \| last7 = Takahashi \| first7 = S. \| last8 = Nakagohri \| first8 = T. \| last9 = Konishi \| first9 = M. \| title = Glypican-3 is a useful diagnostic marker for a component of hepatocellular carcinoma in human liver cancer. \| journal = Int J Oncol \| volume = 34 \| issue = 3 \| pages = 649-56 \| month = Mar \| year = 2009 \| doi = \| PMID = 19212669 \| url = http://www.spandidos-publications.com/serveFile/ijo_34_3_649_PDF.pdf?type=article&article_id=ijo_34_3_649&item=PDF}}</ref>		*[[Glypican-3]] +ve (cytoplasmic, granular cytoplasmic or membranous).<ref name=pmid19212669>{{Cite journal \| last1 = Shirakawa \| first1 = H. \| last2 = Kuronuma \| first2 = T. \| last3 = Nishimura \| first3 = Y. \| last4 = Hasebe \| first4 = T. \| last5 = Nakano \| first5 = M. \| last6 = Gotohda \| first6 = N. \| last7 = Takahashi \| first7 = S. \| last8 = Nakagohri \| first8 = T. \| last9 = Konishi \| first9 = M. \| title = Glypican-3 is a useful diagnostic marker for a component of hepatocellular carcinoma in human liver cancer. \| journal = Int J Oncol \| volume = 34 \| issue = 3 \| pages = 649-56 \| month = Mar \| year = 2009 \| doi = \| PMID = 19212669 \| url = http://www.spandidos-publications.com/serveFile/ijo_34_3_649_PDF.pdf?type=article&article_id=ijo_34_3_649&item=PDF}}</ref>
	*TTF-1 +ve cytoplasmic staining.<ref name=pmid22359993>{{Cite journal \| last1 = Mishra \| first1 = M. \| last2 = Morgan \| first2 = V. \| last3 = Hamati \| first3 = AK. \| last4 = Al-Abbadi \| first4 = M. \| title = Carcinoma of unknown primary: check the liver... thanks to TTF-1. \| journal = Tenn Med \| volume = 105 \| issue = 1 \| pages = 35-6, 40 \| month = Jan \| year = 2012 \| doi = \| PMID = 22359993 }}</ref>		*TTF-1 +ve cytoplasmic staining.<ref name=pmid22359993>{{Cite journal \| last1 = Mishra \| first1 = M. \| last2 = Morgan \| first2 = V. \| last3 = Hamati \| first3 = AK. \| last4 = Al-Abbadi \| first4 = M. \| title = Carcinoma of unknown primary: check the liver... thanks to TTF-1. \| journal = Tenn Med \| volume = 105 \| issue = 1 \| pages = 35-6, 40 \| month = Jan \| year = 2012 \| doi = \| PMID = 22359993 }}</ref>
	**Benign liver also has cytoplasmic staining.		**Benign liver also has cytoplasmic staining.

Mitchell: /* Images */ added case

2016-12-28T19:34:22Z

Images: added case

← Older revision		Revision as of 19:34, 28 December 2016
Line 156:		Line 156:

	Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.		Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.

			[[File:5 04760075043191 sl 1.png\| Hepatocellular carcinoma arising in cirrhosis]]
			[[File:5 04760075043191 sl 2.png\| Hepatocellular carcinoma arising in cirrhosis]]
			[[File:5 04760075043191 sl 3.png\| Hepatocellular carcinoma arising in cirrhosis]]
			[[File:5 04760075043191 sl 4.png\| Hepatocellular carcinoma arising in cirrhosis]]
			[[File:5 04760075043191 sl 5.png\| Hepatocellular carcinoma arising in cirrhosis]]
			[[File:5 04760075043191 sl 6.png\| Hepatocellular carcinoma arising in cirrhosis]]
			[[File:5 04760075043191 sl 7.png\| Hepatocellular carcinoma arising in cirrhosis]]
			[[File:5 04760075043191 sl 8.png\| Hepatocellular carcinoma arising in cirrhosis]]

			Hepatocellular carcinoma superimposed on cirrhosis in a 60 year old man. A. Dark tumor, sometimes with separate cords visible at low power (black arrow), contrasts with lightly colored regenerative nodules (green arrows) within fibrotic bands. B. Regenerative nodules are separated by a band with proliferated bile ducts, whose orientation, lacking haphazard spread, bespeaks a benign process. C. Reticulin of regenerative nodule shows two cell thick cords lacking orientation, disrupted without reason, aggregated and, at left, slighely dispersed. D. Hepatocellular carcinoma shows darker cytoplasm and more nuclei per square mm than regenerative nodules. Note the many acini, also a good sign of cancer. E. Reticulin fibers have disappeared, leaving cords with 6 or more nuclei thick in places. F. PAS D stain shows benign proliferated bile ducts, whose orientation from lower left to upper right deprives the proliferation of the haphazard nature of a cholangiocarcinoma. G. PAS-D shows the cytoplasmic digestion of glycogen in a hepatocellular carcinoma, a helpful hint at times. Note the finger like cords, the mitosis (black arrow), and the occasional acinar lumens (red arrows). H. PAS D of regenerative nodule contrasts with the image of the hepatocellular carcinoma.

	===Fibrolamellar hepatocellular carcinoma===		===Fibrolamellar hepatocellular carcinoma===

Mitchell: /* Images */ Added a case. Changed to better format for others. Depending on one's cell phone or computer, the images may not appear as rows. Hence, the need to letter them.

2016-12-07T22:52:16Z

Images: Added a case. Changed to better format for others. Depending on one's cell phone or computer, the images may not appear as rows. Hence, the need to letter them.

← Older revision		Revision as of 22:52, 7 December 2016
Line 108:		Line 108:
	Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)		Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)
	</gallery>		</gallery>
	{\|		A
	[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			B
	[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	~~<br>~~		C
	[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			D
	[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	~~<br>~~		E
	[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			F
	[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	~~<br>~~		G
	[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			H
	[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	\|}
	~~Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.~~
	Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows] (Row 1 Left 40X). Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow](Row 1 Right 100X). The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei (Row 2 Left 200X). Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion (Row 2 Right 200X). The regenerative focus shows abundant cytoplasm (Row 3 Left 200X). Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines (Row 3 Right 200X). This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis (Row 4 Left 200X). Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

	{\|		Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments. A. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows]. B. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow]. C. The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei. D. Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion. E. The regenerative focus shows abundant cytoplasm. F. Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines. G. This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis. H. Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

			A
	[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]		[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]
			B
	[[File:2 hcc 1 680x512px.tif\|The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).]]		[[File:2 hcc 1 680x512px.tif\|The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).]]
	~~<br>~~		C
	[[File:3 hcc 1 680x512px.tif\|The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).]]		[[File:3 hcc 1 680x512px.tif\|The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).]]
			D
	[[File:4 hcc 1 680x512px.tif\|Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).]]		[[File:4 hcc 1 680x512px.tif\|Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).]]
	\|}
	Hepatocellular carcinoma with acini.		Hepatocellular carcinoma with acini. A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma. B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi. C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow]. D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor.
	Fibrous bands dissect hepatocyte nodules, mostly hepatoma ~~(Row 1 Left 20X)~~. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi ~~(Row 1 Right 100X)~~. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] ~~(Row 2 Left 400X)~~. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor ~~(Row 2 Right 400X)~~.
	{\|		A
	[[File:1 steatohep HCC 6 680x512px.tif\|Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).]]		[[File:1 steatohep HCC 6 680x512px.tif\|Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).]]
			B
	[[File:2 steatohep HCC 6 680x512px.tif\|Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).]]		[[File:2 steatohep HCC 6 680x512px.tif\|Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).]]
	~~<br>~~		C
	[[File:3 steatohep HCC 6 680x512px.tif\|Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).]]		[[File:3 steatohep HCC 6 680x512px.tif\|Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).]]
			D
	[[File:4 steatohep HCC 6 680x512px.tif\|Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).]]		[[File:4 steatohep HCC 6 680x512px.tif\|Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).]]
	\|}
	Hepatocellular carcinoma, steatohepatitic variant.		Hepatocellular carcinoma, steatohepatitic variant. A. Fragments of tumor at low power mimic normal hepatocyte groups without portal triads. B. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows]. D. Chronic inflammatory cells bound some cancer cells. D. Nuclear inclusions [arrows] are occasionally prominent [arrows].
	Fragments of tumor at low power mimic normal hepatocyte groups without portal triads ~~(Row 1 Left 20X)~~. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] ~~(Row 1 Right 400X)~~. Chronic inflammatory cells bound some cancer cells ~~(Row 2 Left 400X)~~. Nuclear inclusions [arrows] are occasionally prominent [arrows] (~~Row 2 Right 400X~~).
			[[File: HCC CL 1 sl 1.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 2.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 3.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 4.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 5.png\| Hepatocellular carcinoma, clear cell variant]]

			Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.

	===Fibrolamellar hepatocellular carcinoma===		===Fibrolamellar hepatocellular carcinoma===

Mitchell: /* Images */ added a well-differentiated hepatoma with a tricky steatosis part

2016-09-05T21:30:52Z

Images: added a well-differentiated hepatoma with a tricky steatosis part

← Older revision		Revision as of 21:30, 5 September 2016
Line 108:		Line 108:
	Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)		Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)
	</gallery>		</gallery>
			{\|
			[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			<br>
			[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			<br>
			[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			<br>
			[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			\|}
			Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
			Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows] (Row 1 Left 40X). Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow](Row 1 Right 100X). The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei (Row 2 Left 200X). Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion (Row 2 Right 200X). The regenerative focus shows abundant cytoplasm (Row 3 Left 200X). Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines (Row 3 Right 200X). This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis (Row 4 Left 200X). Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

	{\|		{\|
	[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]		[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]

Mitchell: /* Images */ added steatohepatitic variant

2016-08-30T20:44:06Z

Images: added steatohepatitic variant

← Older revision		Revision as of 20:44, 30 August 2016
Line 116:		Line 116:
	\|}		\|}
	Hepatocellular carcinoma with acini.		Hepatocellular carcinoma with acini.
	Fibrous bands dissect hepatocyte nodules, mostly hepatoma		Fibrous bands dissect hepatocyte nodules, mostly hepatoma (Row 1 Left 20X). The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X). The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X). Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).
	(Row 1 Left 20X). The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X). The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X). Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).		{\|
			[[File:1 steatohep HCC 6 680x512px.tif\|Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).]]
			[[File:2 steatohep HCC 6 680x512px.tif\|Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).]]
			<br>
			[[File:3 steatohep HCC 6 680x512px.tif\|Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).]]
			[[File:4 steatohep HCC 6 680x512px.tif\|Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).]]
			\|}
			Hepatocellular carcinoma, steatohepatitic variant.
			Fragments of tumor at low power mimic normal hepatocyte groups without portal triads (Row 1 Left 20X). Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X). Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X). Nuclear inclusions [arrows] are occasionally prominent [arrows] (Row 2 Right 400X).

	===Fibrolamellar hepatocellular carcinoma===		===Fibrolamellar hepatocellular carcinoma===

Mitchell: /* Images */ add an hcc

2016-08-26T18:27:17Z

Images: add an hcc

← Older revision		Revision as of 18:27, 26 August 2016
Line 108:		Line 108:
	Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)		Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)
	</gallery>		</gallery>
			{\|
			[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]
			[[File:2 hcc 1 680x512px.tif\|The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).]]
			<br>
			[[File:3 hcc 1 680x512px.tif\|The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).]]
			[[File:4 hcc 1 680x512px.tif\|Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).]]
			\|}
			Hepatocellular carcinoma with acini.
			Fibrous bands dissect hepatocyte nodules, mostly hepatoma
			(Row 1 Left 20X). The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X). The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X). Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).

	===Fibrolamellar hepatocellular carcinoma===		===Fibrolamellar hepatocellular carcinoma===

Michael: /* IHC */

2015-10-29T04:18:22Z

IHC

← Older revision		Revision as of 04:18, 29 October 2015
Line 168:		Line 168:
	*CK8/18 +ve.<ref name=pmid16680226>{{Cite journal \| last1 = Stroescu \| first1 = C. \| last2 = Herlea \| first2 = V. \| last3 = Dragnea \| first3 = A. \| last4 = Popescu \| first4 = I. \| title = The diagnostic value of cytokeratins and carcinoembryonic antigen immunostaining in differentiating hepatocellular carcinomas from intrahepatic cholangiocarcinomas. \| journal = J Gastrointestin Liver Dis \| volume = 15 \| issue = 1 \| pages = 9-14 \| month = Mar \| year = 2006 \| doi = \| PMID = 16680226 }}</ref>		*CK8/18 +ve.<ref name=pmid16680226>{{Cite journal \| last1 = Stroescu \| first1 = C. \| last2 = Herlea \| first2 = V. \| last3 = Dragnea \| first3 = A. \| last4 = Popescu \| first4 = I. \| title = The diagnostic value of cytokeratins and carcinoembryonic antigen immunostaining in differentiating hepatocellular carcinomas from intrahepatic cholangiocarcinomas. \| journal = J Gastrointestin Liver Dis \| volume = 15 \| issue = 1 \| pages = 9-14 \| month = Mar \| year = 2006 \| doi = \| PMID = 16680226 }}</ref>
	*Glypican-3 +ve (cytoplasmic, granular cytoplasmic or membranous).<ref name=pmid19212669>{{Cite journal \| last1 = Shirakawa \| first1 = H. \| last2 = Kuronuma \| first2 = T. \| last3 = Nishimura \| first3 = Y. \| last4 = Hasebe \| first4 = T. \| last5 = Nakano \| first5 = M. \| last6 = Gotohda \| first6 = N. \| last7 = Takahashi \| first7 = S. \| last8 = Nakagohri \| first8 = T. \| last9 = Konishi \| first9 = M. \| title = Glypican-3 is a useful diagnostic marker for a component of hepatocellular carcinoma in human liver cancer. \| journal = Int J Oncol \| volume = 34 \| issue = 3 \| pages = 649-56 \| month = Mar \| year = 2009 \| doi = \| PMID = 19212669 \| url = http://www.spandidos-publications.com/serveFile/ijo_34_3_649_PDF.pdf?type=article&article_id=ijo_34_3_649&item=PDF}}</ref>		*Glypican-3 +ve (cytoplasmic, granular cytoplasmic or membranous).<ref name=pmid19212669>{{Cite journal \| last1 = Shirakawa \| first1 = H. \| last2 = Kuronuma \| first2 = T. \| last3 = Nishimura \| first3 = Y. \| last4 = Hasebe \| first4 = T. \| last5 = Nakano \| first5 = M. \| last6 = Gotohda \| first6 = N. \| last7 = Takahashi \| first7 = S. \| last8 = Nakagohri \| first8 = T. \| last9 = Konishi \| first9 = M. \| title = Glypican-3 is a useful diagnostic marker for a component of hepatocellular carcinoma in human liver cancer. \| journal = Int J Oncol \| volume = 34 \| issue = 3 \| pages = 649-56 \| month = Mar \| year = 2009 \| doi = \| PMID = 19212669 \| url = http://www.spandidos-publications.com/serveFile/ijo_34_3_649_PDF.pdf?type=article&article_id=ijo_34_3_649&item=PDF}}</ref>
			*TTF-1 +ve cytoplasmic staining.<ref name=pmid22359993>{{Cite journal \| last1 = Mishra \| first1 = M. \| last2 = Morgan \| first2 = V. \| last3 = Hamati \| first3 = AK. \| last4 = Al-Abbadi \| first4 = M. \| title = Carcinoma of unknown primary: check the liver... thanks to TTF-1. \| journal = Tenn Med \| volume = 105 \| issue = 1 \| pages = 35-6, 40 \| month = Jan \| year = 2012 \| doi = \| PMID = 22359993 }}</ref>
			**Benign liver also has cytoplasmic staining.

	Bile canaliculi:		Bile canaliculi:

← Older revision		Revision as of 14:12, 11 October 2024
Line 108:		Line 108:
	Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)		Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)
	</gallery>		</gallery>
	A
	[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		====Set 1====
	B		<gallery>
	[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:1 HCC 3 680x512px.tif\|A. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	C		File:2 HCC 3 680x512px.tif\|B. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:3 HCC 3 680x512px.tif\|C. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	D		File:4 HCC 3 680x512px.tif\|D. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:5 HCC 3 680x512px.tif\|E. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	E		File:6 HCC 3 680x512px.tif\|F. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		File:7 HCC 3 680x512px.tif\|G. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	F		File:8 HCC 3 680x512px.tif\|H. Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
	[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		</gallery>
	G
	[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	H
	[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]

	Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments. A. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows]. B. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow]. C. The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei. D. Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion. E. The regenerative focus shows abundant cytoplasm. F. Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines. G. This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis. H. Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).		Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments. A. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows]. B. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow]. C. The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei. D. Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion. E. The regenerative focus shows abundant cytoplasm. F. Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines. G. This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis. H. Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

	A
	~~[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]~~
	B
	~~[[File:2 hcc 1 680x512px.tif\|The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).]]~~
	C
	~~[[File:3 hcc 1 680x512px.tif\|The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).]]~~
	D
	[[File:4 hcc 1 680x512px.tif\|Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).]]

			====Set 2====
			<gallery>
			File:1 hcc 1 680x512px.tif\|A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).
			File:2 hcc 1 680x512px.tif\|B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).
			File:3 hcc 1 680x512px.tif\|C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).
			File:4 hcc 1 680x512px.tif\|D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).
			</gallery>
	Hepatocellular carcinoma with acini. A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma. B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi. C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow]. D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor.		Hepatocellular carcinoma with acini. A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma. B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi. C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow]. D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor.

	A		====Set 3====
	[[File:1 steatohep HCC 6 680x512px.tif\|Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).]]		<gallery>
	B		File:1 steatohep HCC 6 680x512px.tif\|A. Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).
	[[File:2 steatohep HCC 6 680x512px.tif\|Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).]]		File:2 steatohep HCC 6 680x512px.tif\|B. Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).
	C		File:3 steatohep HCC 6 680x512px.tif\|C. Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).
	[[File:3 steatohep HCC 6 680x512px.tif\|Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).]]		File:4 steatohep HCC 6 680x512px.tif\|D. Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).
	D		</gallery>
	[[File:4 steatohep HCC 6 680x512px.tif\|Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).]]

	Hepatocellular carcinoma, steatohepatitic variant. A. Fragments of tumor at low power mimic normal hepatocyte groups without portal triads. B. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows]. D. Chronic inflammatory cells bound some cancer cells. D. Nuclear inclusions [arrows] are occasionally prominent [arrows].		Hepatocellular carcinoma, steatohepatitic variant. A. Fragments of tumor at low power mimic normal hepatocyte groups without portal triads. B. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows]. D. Chronic inflammatory cells bound some cancer cells. D. Nuclear inclusions [arrows] are occasionally prominent [arrows].

	[[File: HCC CL 1 sl 1.png\| Hepatocellular carcinoma, clear cell variant]]		====Set 4====
	[[File: HCC CL 1 sl 2.png\| Hepatocellular carcinoma, clear cell variant]]		<gallery>
	[[File: HCC CL 1 sl 3.png\| Hepatocellular carcinoma, clear cell variant]]		File: HCC CL 1 sl 1.png\| Hepatocellular carcinoma, clear cell variant
	[[File: HCC CL 1 sl 4.png\| Hepatocellular carcinoma, clear cell variant]]		File: HCC CL 1 sl 2.png\| Hepatocellular carcinoma, clear cell variant
	[[File: HCC CL 1 sl 5.png\| Hepatocellular carcinoma, clear cell variant]]		File: HCC CL 1 sl 3.png\| Hepatocellular carcinoma, clear cell variant
			File: HCC CL 1 sl 4.png\| Hepatocellular carcinoma, clear cell variant
			File: HCC CL 1 sl 5.png\| Hepatocellular carcinoma, clear cell variant
			</gallery>

	Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.		Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.

	[[File:5 04760075043191 sl 1.png\| Hepatocellular carcinoma arising in cirrhosis]]		====Set 5====
	[[File:5 04760075043191 sl 2.png\| Hepatocellular carcinoma arising in cirrhosis]]		<gallery>
	[[File:5 04760075043191 sl 3.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 1.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 4.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 2.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 5.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 3.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 6.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 4.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 7.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 5.png\| Hepatocellular carcinoma arising in cirrhosis
	[[File:5 04760075043191 sl 8.png\| Hepatocellular carcinoma arising in cirrhosis]]		File:5 04760075043191 sl 6.png\| Hepatocellular carcinoma arising in cirrhosis
			File:5 04760075043191 sl 7.png\| Hepatocellular carcinoma arising in cirrhosis
			File:5 04760075043191 sl 8.png\| Hepatocellular carcinoma arising in cirrhosis
			</gallery>
	Hepatocellular carcinoma superimposed on cirrhosis in a 60 year old man. A. Dark tumor, sometimes with separate cords visible at low power (black arrow), contrasts with lightly colored regenerative nodules (green arrows) within fibrotic bands. B. Regenerative nodules are separated by a band with proliferated bile ducts, whose orientation, lacking haphazard spread, bespeaks a benign process. C. Reticulin of regenerative nodule shows two cell thick cords lacking orientation, disrupted without reason, aggregated and, at left, slighely dispersed. D. Hepatocellular carcinoma shows darker cytoplasm and more nuclei per square mm than regenerative nodules. Note the many acini, also a good sign of cancer. E. Reticulin fibers have disappeared, leaving cords with 6 or more nuclei thick in places. F. PAS D stain shows benign proliferated bile ducts, whose orientation from lower left to upper right deprives the proliferation of the haphazard nature of a cholangiocarcinoma. G. PAS-D shows the cytoplasmic digestion of glycogen in a hepatocellular carcinoma, a helpful hint at times. Note the finger like cords, the mitosis (black arrow), and the occasional acinar lumens (red arrows). H. PAS D of regenerative nodule contrasts with the image of the hepatocellular carcinoma.		Hepatocellular carcinoma superimposed on cirrhosis in a 60 year old man. A. Dark tumor, sometimes with separate cords visible at low power (black arrow), contrasts with lightly colored regenerative nodules (green arrows) within fibrotic bands. B. Regenerative nodules are separated by a band with proliferated bile ducts, whose orientation, lacking haphazard spread, bespeaks a benign process. C. Reticulin of regenerative nodule shows two cell thick cords lacking orientation, disrupted without reason, aggregated and, at left, slighely dispersed. D. Hepatocellular carcinoma shows darker cytoplasm and more nuclei per square mm than regenerative nodules. Note the many acini, also a good sign of cancer. E. Reticulin fibers have disappeared, leaving cords with 6 or more nuclei thick in places. F. PAS D stain shows benign proliferated bile ducts, whose orientation from lower left to upper right deprives the proliferation of the haphazard nature of a cholangiocarcinoma. G. PAS-D shows the cytoplasmic digestion of glycogen in a hepatocellular carcinoma, a helpful hint at times. Note the finger like cords, the mitosis (black arrow), and the occasional acinar lumens (red arrows). H. PAS D of regenerative nodule contrasts with the image of the hepatocellular carcinoma.

← Older revision		Revision as of 22:52, 7 December 2016
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	Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)		Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)
	</gallery>		</gallery>
	{\|		A
	[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			B
	[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	~~<br>~~		C
	[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			D
	[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	~~<br>~~		E
	[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			F
	[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	~~<br>~~		G
	[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			H
	[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]		[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
	\|}
	~~Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.~~
	Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows] (Row 1 Left 40X). Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow](Row 1 Right 100X). The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei (Row 2 Left 200X). Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion (Row 2 Right 200X). The regenerative focus shows abundant cytoplasm (Row 3 Left 200X). Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines (Row 3 Right 200X). This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis (Row 4 Left 200X). Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

	{\|		Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments. A. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows]. B. Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow]. C. The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei. D. Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion. E. The regenerative focus shows abundant cytoplasm. F. Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines. G. This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis. H. Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

			A
	[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]		[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]
			B
	[[File:2 hcc 1 680x512px.tif\|The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).]]		[[File:2 hcc 1 680x512px.tif\|The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi (Row 1 Right 100X).]]
	~~<br>~~		C
	[[File:3 hcc 1 680x512px.tif\|The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).]]		[[File:3 hcc 1 680x512px.tif\|The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] (Row 2 Left 400X).]]
			D
	[[File:4 hcc 1 680x512px.tif\|Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).]]		[[File:4 hcc 1 680x512px.tif\|Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor (Row 2 Right 400X).]]
	\|}
	Hepatocellular carcinoma with acini.		Hepatocellular carcinoma with acini. A. Fibrous bands dissect hepatocyte nodules, mostly hepatoma. B. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi. C. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow]. D. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor.
	Fibrous bands dissect hepatocyte nodules, mostly hepatoma ~~(Row 1 Left 20X)~~. The fibrous band on right bears proliferating bile ductules; acinar arrangement on left shows holes much larger than canaliculi ~~(Row 1 Right 100X)~~. The tumor has cancerous nuclei; note the bile which makes for absolute diagnostic certainty [arrow] ~~(Row 2 Left 400X)~~. Noncancerous hepatocytes on left can be compared with tumor cells on right. Note increased nuclear crowding & a subtle increment in cytoplasmic basophilia in tumor ~~(Row 2 Right 400X)~~.
	{\|		A
	[[File:1 steatohep HCC 6 680x512px.tif\|Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).]]		[[File:1 steatohep HCC 6 680x512px.tif\|Fragments of tumor at low power mimic normal hepatocyte groups without triads (Row 1 Left 20X).]]
			B
	[[File:2 steatohep HCC 6 680x512px.tif\|Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).]]		[[File:2 steatohep HCC 6 680x512px.tif\|Vacuoles, mostly small, occasionally become large enough to warrant “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] (Row 1 Right 400X).]]
	~~<br>~~		C
	[[File:3 steatohep HCC 6 680x512px.tif\|Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).]]		[[File:3 steatohep HCC 6 680x512px.tif\|Chronic inflammatory cells bound some cancer cells (Row 2 Left 400X).]]
			D
	[[File:4 steatohep HCC 6 680x512px.tif\|Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).]]		[[File:4 steatohep HCC 6 680x512px.tif\|Nuclear inclusions are occasionally prominent [arrows] (Row 2 Right 400X).]]
	\|}
	Hepatocellular carcinoma, steatohepatitic variant.		Hepatocellular carcinoma, steatohepatitic variant. A. Fragments of tumor at low power mimic normal hepatocyte groups without portal triads. B. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows]. D. Chronic inflammatory cells bound some cancer cells. D. Nuclear inclusions [arrows] are occasionally prominent [arrows].
	Fragments of tumor at low power mimic normal hepatocyte groups without portal triads ~~(Row 1 Left 20X)~~. Vacuoles, mostly small, occasionally become large enough to warrant the term “macrovesicular” [green arrows]. Note Mallory hyalin [red arrows] ~~(Row 1 Right 400X)~~. Chronic inflammatory cells bound some cancer cells ~~(Row 2 Left 400X)~~. Nuclear inclusions [arrows] are occasionally prominent [arrows] (~~Row 2 Right 400X~~).
			[[File: HCC CL 1 sl 1.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 2.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 3.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 4.png\| Hepatocellular carcinoma, clear cell variant]]
			[[File: HCC CL 1 sl 5.png\| Hepatocellular carcinoma, clear cell variant]]

			Hepatocellular carcinoma, clear cell variant. Much more difficult on biopsy than on resection is the specific identification of the clear cell variant, although it was done here. Variants are of little clinical significance apart from the fibrolamellar variant. A. Tumor fragment masses with clearing contrast with pink liver fragments. B. Tumor cell cytoplasm on the core biopsy varies, often clear, often light pink and foamy. C. PAS without diastase shows brightly positive tumor cytoplasm. D. Modestly variable, rounded nuclei show open chromatin and nucleoli. Individual pyknotic nuclei (black arrows) are insufficient as evidence of necrosis sufficient to increase grade. D. PAS with diastase shows the material is glycogen. E. At resection, the cytoplasmic clarity at low power is more impressive than on biopsy. F. The high power view of the resection specimen shows the cytoplasm is truly clear. Arrows point to Mallory bodies.

	===Fibrolamellar hepatocellular carcinoma===		===Fibrolamellar hepatocellular carcinoma===

← Older revision		Revision as of 21:30, 5 September 2016
Line 108:		Line 108:
	Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)		Image:Hepatocellular_carcinoma_intermed_mag.jpg \| HCC - intermed mag. (WC)
	</gallery>		</gallery>
			{\|
			[[File:1 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:2 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			<br>
			[[File:3 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:4 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			<br>
			[[File:5 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:6 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			<br>
			[[File:7 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			[[File:8 HCC 3 680x512px.tif\| Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.]]
			\|}
			Hepatocellular carcinoma with fragments of liver afflicted by steatosis & with regenerative, benign fragments.
			Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with steatosis [arrows] (Row 1 Left 40X). Fragments of liver with crowded nuclei, consistent with hepatoma, as well as with larger amount of cytoplasm, consistent with regeneration [arrow](Row 1 Right 100X). The fatty liver below has aberrant-appearing nuclei, but not particularly crowded, in contrast to the fragment on top, which has crowded nuclei (Row 2 Left 200X). Reticulin stain shows apparent expansion of nuclei between black lines on the fatty liver, but this may also be seen with simple steatosis; on the crowded liver note the lack of definite expansion (Row 2 Right 200X). The regenerative focus shows abundant cytoplasm (Row 3 Left 200X). Reticulin on this regenerative focus shows preservation of the low number of nuclei between black lines (Row 3 Right 200X). This typical hepatocellular focus shows crowding, occasional acini, and basophilia, similar to the focus seen in row 2. Note that some cells show apparent steatosis (Row 4 Left 200X). Reticulin on this hepatocellular focus shows loss of reticulin fibers, with more than six nuclei between several black lines (Row 4 Right 200X).

	{\|		{\|
	[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]		[[File:1 hcc 1 680x512px.tif\|Fibrous bands dissect hepatocyte nodules, mostly hepatoma(Row 1 Left 20X).]]