Differentiation of Hepatocellular Carcinoma from Metastatic Carcinoma of the Liver - Clinical and Cytological Features

Differentiation of hepatocellular carcinoma (HCC) from metastatic carcinoma in liver may be difficult on fine needle aspiration cytology (FNAC), when both appear as moderate to poorly differentiated tumours. The present study was done to assess clinical, serological, biochemical, radiological and detailed cytomorphological features to distinguish HCC from metastatic carcinoma in FNAC of the liver masses. The individual cytomorphological features which helped in differentiating HCC from metastatic carcinoma were: hepatocytic appearance of cells (92%), trabecular pattern (92%), naked nuclei (76%), intranuclear inclusions (52%) and bile (40%). The most common clinical presentation in HCC cases was pain abdomen (40%). Positivity for HBsAg was found in 7 (33.3%) cases while anti HCV antibody was detected in 4 (19%) cases. The level of serum alpha fetoprotein (AFP) was elevated in 88.9% cases, but 40% cases showed mild elevation of AFP level. 17/25 cases of HCC had solitary space occupying lesion (SOL) and 8 cases had multiple SOLs. The present study reveals that most useful cytomorphological features in the distinction of HCC from metastatic carcinoma include trabecular pattern, hepatocytic cells, bile pigment, intranuclear inclusions and atypical stripped nuclei in HCC. Viral markers and alpha-fetoprotein estimation can supplement the results. Journal of Cytology 2007; 24 (3) : 125-129