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Hepatic epithelioid hemangioendothelioma: A diagnostic pitfall in aspiration cytology.

Gupta R, Mathur SR, Gupta SD, Durgapal P, Iyer VK, Das CJ - Cytojournal (2010)

Bottom Line: We describe a case of a young healthy adult male who was found to have multiple hepatic masses on radiologic investigations.He is doing well 14 months after diagnosis, without surgical excision or chemotherapy.Since this tumor is usually unresectable but has a favorable prognosis as compared to hepatocellular carcinoma, a correct diagnosis is essential for appropriate management and prognostication.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Hepatic epithelioid hemangioendothelioma (EH) is a rare vascular neoplasm. An accurate radiologic diagnosis is usually difficult due to the presence of multiple nodules, simulating metastatic carcinoma. Though histologic features of this tumor are well described, cytologic reports of hepatic EH are very few in the available literature. We describe a case of a young healthy adult male who was found to have multiple hepatic masses on radiologic investigations. A guided fine needle aspiration demonstrated a poorly differentiated neoplasm. The diagnosis was made on core biopsy assisted by immunohistochemistry, which showed characteristic features of EH. He is doing well 14 months after diagnosis, without surgical excision or chemotherapy. An accurate diagnosis of hepatic EH on aspiration cytology requires an adequate specimen and awareness of its cytologic features, including discohesive atypical cells with intracytoplasmic lumina and intranuclear inclusions. Since this tumor is usually unresectable but has a favorable prognosis as compared to hepatocellular carcinoma, a correct diagnosis is essential for appropriate management and prognostication.

No MeSH data available.


Related in: MedlinePlus

Histological photomicrographs demonstrating singly-lying and cords of cells embedded in a desmoplastic stroma (a, H and E ×100). The tumor cells show intracytoplasmic lumina containing red blood cells (b, H and E ×200). Immunostaining reveals cytoplasmic positivity for CD31 in the tumor cells (c, ×100) and focal positivity for pancytokeratin (d, ×200).
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Figure 0003: Histological photomicrographs demonstrating singly-lying and cords of cells embedded in a desmoplastic stroma (a, H and E ×100). The tumor cells show intracytoplasmic lumina containing red blood cells (b, H and E ×200). Immunostaining reveals cytoplasmic positivity for CD31 in the tumor cells (c, ×100) and focal positivity for pancytokeratin (d, ×200).

Mentions: Biopsy section showed a small fragment of liver parenchyma along with fibrous tissue infiltrated by scattered tumor cells [Figure 3a]. The tumor cells were polygonal (epithelioid) with abundant cytoplasm, vesicular nucleus with prominent nucleolus in some cells. Prominent intracytoplasmic vacuoles were seen in many tumor cells [Figure 3b]. An occasional tumor cell showed intracytoplasmic lumina with red blood cells.


Hepatic epithelioid hemangioendothelioma: A diagnostic pitfall in aspiration cytology.

Gupta R, Mathur SR, Gupta SD, Durgapal P, Iyer VK, Das CJ - Cytojournal (2010)

Histological photomicrographs demonstrating singly-lying and cords of cells embedded in a desmoplastic stroma (a, H and E ×100). The tumor cells show intracytoplasmic lumina containing red blood cells (b, H and E ×200). Immunostaining reveals cytoplasmic positivity for CD31 in the tumor cells (c, ×100) and focal positivity for pancytokeratin (d, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822180&req=5

Figure 0003: Histological photomicrographs demonstrating singly-lying and cords of cells embedded in a desmoplastic stroma (a, H and E ×100). The tumor cells show intracytoplasmic lumina containing red blood cells (b, H and E ×200). Immunostaining reveals cytoplasmic positivity for CD31 in the tumor cells (c, ×100) and focal positivity for pancytokeratin (d, ×200).
Mentions: Biopsy section showed a small fragment of liver parenchyma along with fibrous tissue infiltrated by scattered tumor cells [Figure 3a]. The tumor cells were polygonal (epithelioid) with abundant cytoplasm, vesicular nucleus with prominent nucleolus in some cells. Prominent intracytoplasmic vacuoles were seen in many tumor cells [Figure 3b]. An occasional tumor cell showed intracytoplasmic lumina with red blood cells.

Bottom Line: We describe a case of a young healthy adult male who was found to have multiple hepatic masses on radiologic investigations.He is doing well 14 months after diagnosis, without surgical excision or chemotherapy.Since this tumor is usually unresectable but has a favorable prognosis as compared to hepatocellular carcinoma, a correct diagnosis is essential for appropriate management and prognostication.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Hepatic epithelioid hemangioendothelioma (EH) is a rare vascular neoplasm. An accurate radiologic diagnosis is usually difficult due to the presence of multiple nodules, simulating metastatic carcinoma. Though histologic features of this tumor are well described, cytologic reports of hepatic EH are very few in the available literature. We describe a case of a young healthy adult male who was found to have multiple hepatic masses on radiologic investigations. A guided fine needle aspiration demonstrated a poorly differentiated neoplasm. The diagnosis was made on core biopsy assisted by immunohistochemistry, which showed characteristic features of EH. He is doing well 14 months after diagnosis, without surgical excision or chemotherapy. An accurate diagnosis of hepatic EH on aspiration cytology requires an adequate specimen and awareness of its cytologic features, including discohesive atypical cells with intracytoplasmic lumina and intranuclear inclusions. Since this tumor is usually unresectable but has a favorable prognosis as compared to hepatocellular carcinoma, a correct diagnosis is essential for appropriate management and prognostication.

No MeSH data available.


Related in: MedlinePlus