Hepatocellular carcinoma typically displays:
- Trabecular pattern surrounded by layer of flattened endothelial cells.
- Presence of sinusoidal vessels surrounding tumor cells
- Scant stroma, and minimal desmoplasia
- Polygonal cells with distinct cell membranes
- Abundant granular eosinophilic cytoplasm
- Nuclei with increased N/C ratio, round nuclei with coarse chromatin and thickened nuclear membrane, and may have prominent nucleoli.
Hepatocellular adenoma versus carcinoma
A hepatocellular adenoma, in contrast to a carcinoma, has a well-defined border between the lesion and background liver, and is composed of hepatocytes with less significant cytologic atypia.
Both hepatocellular adenoma and well-differentiated hepatocellular carcinoma may display:
- Steatosis: A steatotic hepatocellular carcinoma is a common variant, found most commonly in small, well-differentiated tumors.
- Portal triads, which commonly persist in well-differentiated hepatocellular carcinomas.
Differentiations of hepatocellular carcinoma are:
- Well differentiated:
- Thin plates (1 - 3 hepatocytes thick)
- Hepatocytes are smaller than normal
- Abnormal reticulin network
- Minimal nuclear atypia
- Nuclear density of 2x compared to normal liver
- Moderately differentiated:
- Trabecular pattern at least 4 cells thick
- Larger cells with more eosinophilic cytoplasm
- Distinct nucleoli
- Poorly differentiated:
- Large tumor cells with hyperchromatic nuclei in compact growth pattern
- Rare trabeculae or bile
- Prominent pleomorphism
- May have spindle cell or small cell areas
For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines.
- See also: General notes on reporting
- Table 37.2 in: Sternberg, Stephen (2012). Sternberg's diagnostic surgical pathology . Place of publication not identified: LWW. ISBN 978-1-4511-5289-0. OCLC 953861627.
- Deepali Jain. Liver & intrahepatic bile ducts - Hepatocellular carcinoma - Hepatocellular carcinoma overview. PathologyOutlines. Topic Completed: 1 February 2012. Minor changes: 30 September 2020
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- Author: Avani Pendse, M.D., Ph.D.. Liver & intrahepatic bile ducts - Benign / nonneoplastic - Hepatocellular adenoma. Pathology Outlines. Topic Completed: 1 October 2018. Minor changes: 30 September 2020
- Chan, Anthony W H; Yu, Shuangni; Yu, Yau-Hei; Tong, Joanna H M; Wang, Lei; Tin, Edith K Y; Chong, Charing C N; Chan, Stephen L; et al. (2016). "Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse ". Histopathology 69 (6): 971–984. doi:10.1111/his.13029. ISSN 03090167.
- Motohashi, Ikuko; Okudaira, Masahiko; Takai, Tomoko; Kaneko, Satoshi; Ikeda, Noriaki (1992). "Morphological differences between hepatocellular carcinoma and hepatocellular carcinomalike lesions ". Hepatology 16 (1): 118–126. doi:10.1002/hep.1840160120. ISSN 02709139.