Renshaw Andrew A, Haja Jennifer, Wilbur David C, Miller Theodore R
Department of Pathology, Baptist Hospital of Miami, Miami, FL 33156, USA.
Arch Pathol Lab Med. 2006 Jan;130(1):19-22. doi: 10.5858/2006-130-19-FAOHCT.
The cytologic features of hepatocellular carcinoma in fine-needle aspirates are well described. While some cases are easily distinguished from adenocarcinoma, poorly differentiated tumors can be difficult to differentiate. We reviewed the cytologic findings for 9 aspirates from cases of hepatocellular carcinoma that were frequently misclassified as adenocarcinoma and compared them with another 10 cases of hepatocellular carcinoma that were rarely misclassified.
To compare the cytologic features of cases of hepatocellular carcinoma in fine-needle aspirates that were both rarely and frequently misclassified as adenocarcinoma.
We reviewed a total of 762 interpretations from 19 different cases of hepatocellular carcinoma in liver fine-needle aspiration specimens in the College of American Pathologists Nongynecologic Cytology Program and correlated the cytologic features with performance in the program.
Overall, cases that were frequently misclassified as adenocarcinoma were misclassified 39% of the time (range, 18%-70%), while cases that were rarely misclassified were classified as adenocarcinoma 2% of the time (range, 0%-8%). The difference was statistically significant (P < .001). On review, 4 cytologic patterns were found. The most common pattern for cases that were rarely misclassified was prominent trabeculae of cells and endothelial cells wrapping the trabeculae (6/10 cases vs 2/9 cases that were frequently misclassified). The most common pattern among cases that were frequently misclassified was clusters of cells with granular cytoplasm and associated stripped nuclei (5/9 cases vs 2/10 cases that were rarely misclassified). However, the distribution of neither pattern was significantly different (P = .16 for both). One case with large atypical granular cells, as seen in the fibrolamellar variant, was rarely misclassified. The remaining 3 cases (2 frequently misclassified, 1 rarely misclassified) had a nonspecific a pattern of cells with granular cytoplasm without obvious trabeculae or stripped nuclei.
Correctly classifying hepatocellular carcinoma by cytology alone remains a significant challenge. While some patterns are more common in cases that performed well and other patterns are more common in cases that performed poorly, there was no significant difference in the distribution of these patterns. These results suggest that people should support their interpretations of aspirations with either immunologic evidence, biopsy evidence, or review by an experienced cytopathologist. Continued educational efforts in this area may be of value.
细针穿刺抽吸物中肝细胞癌的细胞学特征已有详尽描述。虽然有些病例很容易与腺癌区分开来，但低分化肿瘤可能难以鉴别。我们回顾了9例经常被误诊为腺癌的肝细胞癌病例的细胞学检查结果，并将其与另外10例很少被误诊的肝细胞癌病例进行了比较。
比较细针穿刺抽吸物中很少和经常被误诊为腺癌的肝细胞癌病例的细胞学特征。
我们回顾了美国病理学家学会非妇科细胞学项目中19例肝细针穿刺标本中762份来自肝细胞癌不同病例的诊断结果，并将细胞学特征与该项目中的诊断表现相关联。
总体而言，经常被误诊为腺癌的病例误诊率为39%（范围为18% - 70%），而很少被误诊的病例被误诊为腺癌的比例为2%（范围为0% - 8%）。差异具有统计学意义（P <.001）。经复查，发现了4种细胞学模式。很少被误诊的病例中最常见的模式是明显的细胞小梁以及包裹小梁的内皮细胞（10例中有6例，而经常被误诊的9例中有2例）。经常被误诊的病例中最常见的模式是具有颗粒状细胞质和相关裸核的细胞簇（9例中有5例，而很少被误诊的10例中有2例）。然而，这两种模式的分布均无显著差异（两者P = 0.16）。1例具有大的非典型颗粒细胞（如纤维板层样变体中所见）的病例很少被误诊。其余3例（2例经常被误诊，1例很少被误诊）具有非特异性的细胞模式，细胞质呈颗粒状，无明显小梁或裸核。
仅通过细胞学正确诊断肝细胞癌仍然是一项重大挑战。虽然有些模式在诊断表现良好的病例中更常见，而其他模式在诊断表现不佳的病例中更常见，但这些模式的分布没有显著差异。这些结果表明，人们应该用免疫证据、活检证据或由经验丰富的细胞病理学家复查来支持他们对穿刺抽吸物的诊断。在这一领域持续开展教育工作可能会有价值。
