Ch. 13 - Liver Flashcards Preview

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Flashcards in Ch. 13 - Liver Deck (30)
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1
Q

What types of liver pathology are amenable to FNA sampling?

A

Liver masses; not for diffuse disease (cirrhosis, hepatitis) which relies on architecture for Dx.

2
Q

What are the normal cellular elements of liver?

A

Hepatocytes, bile duct epithelium, Kupffer cells, and sheets of mesothelial cells.

3
Q

Describe the morphology of hepatocytes.

A

Large polygonal cells with round central nuclei (sometimes multinucleated). Cytoplasm is abundant and granular and may contain lipofuscin, hemosiderin, or bile. Look for trabeculae.

4
Q

Describe the morphology of bile duct epithelium and Kupffer cells.

A

Bile duct epithelium: Cuboidal/flat cohesive cells arranged in honeycombs.

Kupffer cells: Basically macrophages, sometimes hemosiderin-laden.

5
Q

Describe the cytology of bacterial/fungal and amebic abscesses.

A

Bacterial/fungal: Acute infiltrate, debris, maybe organisms

Amebic: Anchovy paste gross appearance. Necrosis with little inflammation. Trophozoites (resemble histiocytes with ingested RBCs).

6
Q

Describe the cytology of echinococcal cysts.

A

Fragments of laminated membrane, sometimes with scolices or hooklets.

7
Q

What types of non-parasitic cysts can be found in the liver?

A

Cuboidal or columnar (biliary), ciliated, mucinous (bile duct cystadenoma).

8
Q

Describe the cytology of cirrhosis.

A

Normal appearing hepatocytes, maybe some steatosis and focal atypia. Need to get core biopsy…

9
Q

Describe the cytology of FNH.

A

Normal looking hepatocytes, maybe some steatosis and bile ductular cells.

10
Q

Distinguish between the clinical significance and cytology of FNH and hepatic adenoma.

A

Both affect adult women. FNH can be recognized clinically by its radiologic central scar. Bile duct epithelium should not be seen in hepatic adenoma, which also confers a minor risk of HCC transformation.

11
Q

Describe the cytology of hepatic adenoma.

A

Normal appearing hepatocytes, some steatosis and naked arterioles.

12
Q

Describe the cytology of bile duct hamartoma (“von meyenberg complex”).

A

Hypocellular specimen containing many benign ductal cells and some hepatocytes.

13
Q

Describe the cytology of liver angioma.

A

3-D arcades of spindled cells with blood, maybe some hepatocytes.

14
Q

When is hepatic angiomyolipoma sampled?

A

Only when it is fat-poor and cannot be recognized as AML on imaging, analogous to those of the retroperitoneum.

15
Q

Describe the cytology of angiomyolipoma.

A

Fat cells, blood vessels, and spindled to epithelioid myoid cells. May have some EMH.

16
Q

What are some normal markers of benign hepatocytes?

A

HepPar1, TTF-1 (cytoplasmic only), ARG-1, CAM5.2, polyclonal CEA (canalicular pattern).

17
Q

What are the three architectural patterns of usual HCC?

A

Trabecular, pseudoglandular (acinar), and compact.

18
Q

What are the variants of HCC?

A
Fibrolamellar (young pts, good px)
Sarcomatoid
Scirrhous 
Lymphoepithelioma-like
Undifferentiated
19
Q

What histologic features are distinct for HCC?

A

Hyaline (Mallory) bodies, globular hyaline bodies, and bile.

20
Q

Describe the cytology of well-differentiated HCC.

A

Highly cellular smears of enlarged hepatocytes with high N:C ratios arranged in thick plates. Hyaline intracytoplasmic globules.

21
Q

Describe the cytology of HCC, fibrolamellar variant

A

Large polygonal cells with abundant eosinophilic cytoplasm and dense bands of fibrosis. Hyaline intracytoplasmic globules.

22
Q

Describe the cytology of cholangiocarcinoma.

A

Isolated cells or crowded sheets with glandular differentiation and nuclear enlargement.

23
Q

What are the risk factors for cholangiocarcinoma. Where can they occur?

A

Liver fluke, PSC, nonbiliary cirrhosis, thorotrast, vinyl chlorides. May be intrahepatic or extrahepatic (hilar = “Klatskin”).

24
Q

Describe the cytology of hepatoblastoma.

A

Similar to that of HCC but within the spectrum of SRBCTs

25
Q

Describe the cytology of angiosarcoma.

A

May be well-differentiated (spindled, syncytial) or poorly differentiated (epithelioid, even rhabdoid). Vacuolated cytoplasm. Look for anastomosing vascular pattern on cell blocks.

26
Q

Describe the cytology of epithelioid hemangioendothelioma.

A

Hypocellular specimen; large polymorphous cells with folded nuclear outline and some giant cells.

27
Q

What cancers are very likely to metastasize to liver?

A

Colorectal, lung, pancreas, stomach, and breast.

28
Q

What stains are helpful for distinguishing HCC from benign liver?

A

Reticulin stain (for architecture, generally not helpful in cytology) and glypican-3 (GPC3) which is positive in HCC but not benign hepatocyte.

29
Q

What stains are helpful for diagnosing NETs? What about pancreatic NETs?

A

Synaptophysin, chromogranin, CD56.

Pancreatic: Islet-1 and PAX-8.

30
Q

What stains distinguish seminoma/dysgerminoma from embryonal carcinoma and yolk sac tumor?

A

Seminoma: PLAP, CD117, OCT-3/4, NANO-G, SALL4.

Embryonal/Yolk: AFP, EMA, CEA, Keratins.