PG Corner- Case 15

Written by | HISTOPATHOLOGY, PG CORNER

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Background

A 22 year old male presented with abdominal pain. CT angiography of abdomen revealed a well defined lobulated exophytic lesion arising from left lobe of liver measuring 18 x 12 cm, showing early arterial enhancement.  Serum AFP: 2.9ng/ml. Biopsy from liver.

Microscopy

Fig.15a; H&E; 5x

Fig.15b; H&E; 10x

Fig.15c; H&E; 20x

Fig.15d; H&E; 20x

Fig.15e; CK7

Fig.15f; CK20

Fig.15g; HepPar-1

Fig.15h; CD68


Click here to reveal the description

Questions & Answers:

  1. What is your diagnosis?
    • Hepatocellular carcinoma- Classic
    • Fibrolamellar HCC
    • Cholangiocarcinoma
    • Cirrohotic liver
  2. Which of the following findings are expected in the background liver, in this case?
    • Viral hepatitis
    • Steatosis
    • Cirrhosis
    • Normal liver
  3. Which of the following genetic change is diagnostic of this tumor?
    • TP53
    • β-catenin
    • DNAJB1-PRKACA fusion
    • All
    • None

Click here to see the answers

  • Occurs in non cirrhotic liver in young adults
  • More common in females
  • Serum AFP levels are normal
  • 60-70% cases are solitary but multiple tumors in form of satellite lesions are known.
  • Grossly:
    • Often well circumscribed but unencapsulated lobulated mass
    • Central scar can be present but does not show enhancement on CT
  • Differential Diagnosis:
    • Classic hepatocellular carcinoma
    • Focal nodular hyperplasia
    • Cholangiocarcinoma
    • Metastatic carcinoma
  • Immunohistochemistry:
    • Positive stains: CK7, CD68, HepPar-1, CEA, Glypican-3
    • Negative stains: p53 and β-catenin
  • Molecular hallmark:
    • Del 19 leading to  formation of DNAJB1-PRKACA  fusion transcript
  • Treatment and prognosis:
    • Aggressive tumor
    • However, several studies have shown better outcome in these patients than classic HCC
    • Excision is treatment of choice
    • When resection is not possible, liver transplantation remains the only option.

Contributed by: Dr. Garima Durga 

Compiled by: Dr Himanshi Diwan


In case of queries, email us at: kumar.ankur@rgcirc.org

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Last modified: 29/07/2021

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