Iyer Venkateswaran K, Kapila Kusum, Agarwala Sandeep, Verma Kusum
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Acta Cytol. 2005 Jul-Aug;49(4):355-64. doi: 10.1159/000326166.
To delineate the cytomorphologic appearances of hepatoblastoma (HBL) in the largest series to date and to evaluate the feasibility of subtyping on fine needle aspiration cytology (FNAC).
Papanicolaou- and May-Grünwald-Giemsa-stained smears of aspirates from 26 cases of HBL were analyzed by 2 observers. Histologic material, available in 15 cases, was correlated. A cytology grouping system was proposed on the basis of which all cases were classified.
The ages of the patients ranged from 4 months to 9 years. Twenty-five cases were categorized as epithelial HBL, with epithelial fragments showing a trabecular arrangement and acinar formation in all, and extramedullary hemopoiesis in 20 cases. It was possible to differentiate fetal and embryonal areas on FNAC. Six cases showed only fetal elements (cytology group F), characterized by cells with abundant cytoplasm and a small, rounded nucleus resembling a normal fetal hepatocyte. The chromatin was finely granular, with a single, central nucleolus. Pleomorphism and mitoses were not seen, and the nuclear/cytoplasmic ratio was < or = 1/3. Fourteen cases showed, in addition to fetal elements, an embryonal component characterized by cells with scant cytoplasm, a pleomorphic nucleus, N/C ratio of > or = 3/1, coarsely granular chromatin and 2-4 angulated nucleoli. Mitoses were seen in these cells (1-4/1,000 cells). Of these 14 cases, 6 showed predominantly fetal and scant embryonal cells, while 8 cases showed fetal and embryonal components in equal amounts (cytology groups Fe and FE, respectively). Four cases showed predominantly embryonal cells (cytology group E). One case was unclassifiable (U). On histology, 8 of 14 cases were of mixed epithelial and mesenchymal type, but mesenchymal tissue was not seen on the corresponding cytology. The cytology grouping system correlated well with histology. One case was small cell undifferentiated HBL and resembled a round cell tumor without differentiation. Macrotrabecular arrangement was not seen on cytology but was seen on histology in 1 case.
Epithelial HBL can be easily diagnosed in aspirates further classified into fetal and embryonal subtypes, which may be of prognostic relevance. The proposed cytology grouping system is effective in semiquantification of the observed subtypes.
在迄今为止最大规模的系列研究中描绘肝母细胞瘤（HBL）的细胞形态学表现，并评估细针穿刺细胞学检查（FNAC）进行亚型分类的可行性。
2名观察者对26例HBL抽吸物的巴氏染色和May-Grünwald-Giemsa染色涂片进行分析。对15例可获得的组织学材料进行相关性分析。提出了一种细胞学分组系统，并据此对所有病例进行分类。
患者年龄范围为4个月至9岁。25例被归类为上皮性HBL，上皮碎片均呈小梁状排列并形成腺泡，20例有髓外造血。在FNAC上能够区分胎儿型和胚胎型区域。6例仅显示胎儿型成分（细胞学组F），其特征为细胞胞质丰富，核小而圆，类似正常胎儿肝细胞。染色质呈细颗粒状，有单个中央核仁。未见多形性和有丝分裂，核/质比≤1/3。14例除胎儿型成分外，还显示胚胎型成分，其特征为细胞胞质稀少，核多形性，N/C比≥3/1，染色质粗糙颗粒状，有2 - 4个角形核仁。这些细胞可见有丝分裂（1 - 4/1000个细胞）。在这14例中，6例主要为胎儿型细胞且胚胎型细胞稀少，8例胎儿型和胚胎型成分数量相等（分别为细胞学组Fe和FE）。4例主要为胚胎型细胞（细胞学组E）。1例无法分类（U）。组织学上，14例中有8例为上皮和间叶混合型，但相应的细胞学检查未见间叶组织。细胞学分组系统与组织学相关性良好。1例为小细胞未分化HBL，类似未分化的圆形细胞瘤。细胞学检查未见大的小梁状排列，但1例组织学检查可见。
上皮性HBL在抽吸物中易于诊断，可进一步分为胎儿型和胚胎型亚型，这可能与预后相关。所提出的细胞学分组系统对观察到的亚型进行半定量有效。
