Sigamani E, Iyer V K, Agarwala S
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
Cytopathology. 2010 Dec;21(6):398-402. doi: 10.1111/j.1365-2303.2010.00739.x.
Fine needle aspiration cytology (FNAC) of infantile haemangioendothelioma of the liver (IHL) has not previously been described because routine use of FNAC is contraindicated due to the risk of bleeding.
Two patients presented with progressively increasing right upper quadrant abdominal mass. The index case was a girl aged two and a half years with a large single mass in the right lobe of the liver. The second was a 3-month-old girl in whom ultrasonography revealed multiple hypoechoic lesions in the liver. Ultrasound-guided fine needle aspiration had been performed on both patients. May-Grünwald-Giemsa stained smears from these two patients were reviewed and correlated with histopathology.
Both aspirates showed predominantly normal hepatocytes and bile ductules amongst which tumour cells were admixed. The latter were oval to spindle-shaped with scant cytoplasm and wavy, kinked and indented nuclear outlines. The non-epithelial character of the tumour cells was apparent and helped to rule out hepatoblastoma. One case showed extramedullary haemopoiesis. The diagnosis of IHL was established on subsequent excision in the first case and a wedge biopsy in the second case. CD34 and factor VIII R antigen were positive in the tumour cells.
Radiological diagnosis of IHL is possible in a majority of cases, but sometimes features may overlap with hepatoblastoma and fine needle aspiration may be performed inadvertently. Characteristic kinked nuclei and intermixed normal liver tissue might suggest IHL in the differential diagnosis of a spindle cell vasoformative tumour.
肝婴儿血管内皮瘤（IHL）的细针穿刺细胞学检查（FNAC）此前尚未见报道，因为由于出血风险，常规使用FNAC是禁忌的。
两名患者出现右上腹肿块逐渐增大。首例患者为一名两岁半的女孩，肝脏右叶有一个巨大的单发肿块。第二例是一名3个月大的女孩，超声检查发现肝脏有多个低回声病变。对两名患者均进行了超声引导下的细针穿刺。对这两名患者的May-Grünwald-Giemsa染色涂片进行了复查，并与组织病理学结果进行了对比。
两份穿刺物主要显示正常肝细胞和胆小管，其中混有肿瘤细胞。后者呈椭圆形至梭形，细胞质稀少，核轮廓呈波浪状、扭结状和凹陷状。肿瘤细胞的非上皮特征明显，有助于排除肝母细胞瘤。一例显示髓外造血。第一例通过后续切除、第二例通过楔形活检确诊为IHL。肿瘤细胞中CD34和因子VIII R抗原呈阳性。
大多数情况下IHL的影像学诊断是可行的，但有时其特征可能与肝母细胞瘤重叠，可能会无意中进行细针穿刺。在梭形细胞血管形成性肿瘤的鉴别诊断中，特征性的扭结状核和混合的正常肝组织可能提示IHL。
