Cytologie hépatique

Question 1

FNA du foie

Answer 1

Hépatocytes normaux

Hepatocytes have abundant granular cytoplasm, a round and regular nucleus (or two), and a prominent nucleolus. They are arranged as a ribbon of two cells’ width. Lipofuscin, the normal “wear and tear” pigment, is present (arrow) (Papanicolaou stain).

Question 1

FNA du foie

Answer 1

Hépatocytes normaux

Lipofuscin appears greenish with the Romanowsky stains. A pseudoinclusion is present (Romanowsky stain).

Question 2

FNA du foie

Patient cirrhotique

Answer 2

Bile

Bile pigment is not usually seen unless there is bile stasis. With the Romanowsky stains, bile pigment is a dense, dark greenish-black pigment in the cytoplasm of hepatocytes (arrow). This case is from a patient with cirrhosis (Romanowsky stain).

Question 3

FNA du foie

Answer 3

Stéatose

This patient had a long-standing history of alcohol abuse, and diffuse nodularity was noted on computed tomography. Fine-needle aspiration demonstrated abundant fatty changes (Papanicolaou stain).

Question 4

FNA du foie

Answer 4

Kyste hydatide

(B) Rarely, an intact scolex and numerous hooklets are identified (Papanicolaou stain).

Question 5

FNA du foie

Answer 5

Hémangiome

(A) Smears show occasional tangles of spindle-shaped cells that are difficult to classify (Papanicolaou stain).

Question 6

FNA du foie

Answer 6

Carcinome hépatocellulaire pauvrement différencié

(B) Poorly differentiated tumors show little if any hepatocellular differentiation; they resemble poorly differentiated cholangiocarcinomas and metastatic carcinomas (Papanicolaou stain).

Question 7

FNA du foie

Answer 7

Carcinome hépatocellulaire

A markedly cellular ­preparation with abundant naked nuclei is characteristic of many hepatocellular carcinomas (Romanowsky stain).

Question 8

FNA du foie

Answer 8

Carcinome hépatocellulaire type trabéculaire

(A) Thick (>2 cells across) trabeculae are a characteristic feature of the classic hepatocellular carcinoma with a prominent trabecular pattern. Note the increased nuclear-to-cytoplasmic ratio of the neoplastic hepatocytes and the flat endothelial cells with spindle-shaped nuclei that wrap the trabeculae (Papanicolaou stain).

Question 8

FNA du foie

Answer 8

Carcinome hépatocellulaire type trabéculaire

(A) Thick (>2 cells across) trabeculae are a characteristic feature of the classic hepatocellular carcinoma with a prominent trabecular pattern. Note the increased nuclear-to-cytoplasmic ratio of the neoplastic hepatocytes and the flat endothelial cells with spindle-shaped nuclei that wrap the trabeculae (Papanicolaou stain).

Question 9

FNA du foie

Answer 9

Carcinome hépatocellulaire type acinaire

The cords of neoplastic cells are arranged in acini. Note the increased nuclear-to-cytoplasmic ratio, a key feature in the diagnosis of hepatocellular carcinoma (Papanicolaou stain).

Question 10

FNA du foie

Answer 10

Carcinome hépatocellulaire

Prominent transgressing vessels are characteristic of hepatocellular carcinoma (Papanicolaou stain).

Question 11

FNA du foie

Answer 11

Hépatocytes avec bile (carcinome hépatocellulaire, mais je pense pas qu’on peut le dire ici)

Question 12

FNA du foie

Answer 12

Carcinome hépatocellulaire pauvrement différencié

A, Bizarre, atypical forms including spindle cells with intracytoplasmic globules are noted (smear, Romanowsky stain).

Question 13

FNA du foie

Answer 13

Carcinome hépatocellulaire variante à cellules claires

(A) As with many hepatocellular carcinomas, abundant bare nuclei are present. The cells have been disrupted, and the abundant spilled cytoplasmic glycogen gives a mottled appearance to the background that is reminiscent of the “tigroid” background seen with another glycogen-rich tumor, the seminoma (see Fig. 2.48) (Romanowsky stain).

Question 14

FNA du foie

Answer 14

Carcinome hépatocellulaire, changement adipeux

The malignant cells are distended by sharply outlined, large fat vacuoles (Romanowsky stain).

Question 15

FNA du foie

Answer 15

Carcinome hépatocellulaire, changement adipeux

The malignant cells are distended by sharply outlined, large fat vacuoles (Romanowsky stain).

Question 16

FNA du foie

Answer 16

Carcinome hépatocellulaire variante fibrolamellaire

(A) Large, atypical hepatocytes are accompanied by fibrous tissue. (B) The malignant cells have abundant granular cytoplasm and intracytoplasmic hyaline globules (arrows) (Papanicolaou stain).

Question 17

FNA du foie

Answer 17

Carcinome hépatocellulaire variante fibrolamellaire

(A) Large, atypical hepatocytes are accompanied by fibrous tissue. (B) The malignant cells have abundant granular cytoplasm and intracytoplasmic hyaline globules (arrows) (Papanicolaou stain).

Question 18

FNA hépatique

Answer 18

Cholangiocarcinome

(A) The tumor cells are in crowded sheets. Haphazard cellular arrangement and glandular differentiation are apparent (Papanicolaou stain). (B) Anisonucleosis and nuclear membrane irregularity are present (Romanowsky stain).

Question 19

FNA du foie chez une enfant de 7 mois

Answer 19

Hépatoblastome

Question 20

FNA du foie

Answer 20

Carcinome colique métastatique

The columnar, picket-fence arrangement is apparent on smears as well. Nuclei are enlarged and ovoid (smear, Papanicolaou stain).

Question 21

FNA du foie

Answer 21

TNE métastatique

Question 22

FNA du foie

Answer 22

SCNEC

(A) Note the abundant small blue cells with scant cytoplasm and pronounced molding. Nuclear crush artifact is prominent (Romanowsky stain).

Question 23

FNA du foie

Answer 23

SCNEC (B) The cells are isolated and arranged in loosely cohesive clusters. The nuclear-to-cytoplasmic ratio is very high, nuclear molding is seen, and the chromatin is finely granular without nucleoli (Papanicolaou stain).

Question 24

FNA du foie

Answer 24

Mélanome métastatique

Question 25

FNA du foie

Answer 25

GIST (A) There are cohesive groups of spindle-shaped cells. Nuclear atypia is minimal in this case (Papanicolaou stain).