Clinicocytological Analysis of Hepatic Neoplastic Lesions

Garg Rachana, Anuradha Rao
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Abstract

Background: The liver is the site of numerous neoplastic and non-neoplastic lesions, with neoplastic lesions accounting for a prominent cause of morbidity and mortality. Being a common site for metastatic tumors, it becomes imperative to differentiate the same from hepatocellular carcinoma, owing to varied management modalities involved. Diagnosis by fine needle aspiration cytology (FNAC),is considered a prominent investigative procedure in this regard. However, it is not without its limitations and disadvantages. Aim and Objectives: This retrospective research analyzes the cytological features of hepatic masses, with particular reference to pattern assessment, cellular and nuclear details along with background characteristics of note which could define differentiating characteristics of hepatocellular carcinoma from metastatic malignancy. Accompanying clinico-radiological and biochemical parameters that could be helpful in this regard were also studied. An attempt was also made to distinguish the features characteristic to different grades of hepatocellular carcinoma (HCC). Method: FNAC of 114 hepatic neoplastic lesions received during a two years period in the pathology department of a tertiary care hospital were retrospectively analyzed. Clinico-radiological and biochemical parameters were correlated, and data thus retrieved was analyzed statistically for relevance. Results: Males were predominantly affected both by primary and metastatic malignancy with primary over 60 years of age. Jaundice, history of prior alcohol consumption, pre-existing liver disease, elevated LFT along with AFP levels >400 ng/ml was seen in significant cases of hepatocellular carcinoma. Radiologically, metastasis showed multiple lesions with most cases less than 5cms in diameter with invasion of adjacent structures. Analysis of three characteristic cytological features including presence of cytoplasmic bile, intranuclear inclusions and traversing blood vessel was carried out and it was observed that the highest chance of tumor being HCC was when all three were seen. After analyzing features to differentiate between the different grades of HCC it was observed that as the grades progressed the cells became undifferentiated and similarities increased. Cytohistological correlation was seen in 91.3% of cases of primary and 86.9% of metastatic malignancies. Conclusion: Close attention to cytological features like cell clusters, intranuclear inclusions, endothelial rimming in conjunction with radiological images and biochemical markers provide valuable pointers in distinguishing between primary HCC and hepatic metastatic carcinomas thus obviating the need of invasive procedures.
肝脏肿瘤病变的临床细胞学分析
背景:肝脏是许多肿瘤和非肿瘤病变的部位,其中肿瘤病变是发病率和死亡率的重要原因。作为转移性肿瘤的常见部位,由于涉及不同的治疗方式,必须将其与肝细胞癌区分开来。细针抽吸细胞学(FNAC)诊断被认为是这方面的重要调查程序。然而,它并非没有局限性和缺点。目的和目的:本回顾性研究分析肝脏肿块的细胞学特征,特别是参考模式评估、细胞和核细节以及值得注意的背景特征,这些特征可以定义肝细胞癌与转移性恶性肿瘤的鉴别特征。伴随的临床放射学和生化参数可能有助于这方面也进行了研究。我们也试图区分不同级别的肝细胞癌的特征。方法:回顾性分析某三级医院病毒科两年来收治的114例肝肿瘤的FNAC。临床放射学和生化参数相关,并对检索到的数据进行统计学分析。结果:原发性和转移性恶性肿瘤以男性为主,原发年龄在60岁以上。黄疸、既往饮酒史、既往肝病、LFT升高以及AFP水平bb0 ~ 400ng /ml在肝细胞癌的显著病例中可见。放射学表现为多发病灶,多数为直径小于5ms,并侵犯邻近组织。分析三个典型的细胞学特征,包括存在胞质胆汁、核内包涵体和穿越血管,观察到当这三个特征都出现时,肿瘤为HCC的可能性最高。在分析特征以区分不同级别的HCC后,我们观察到,随着级别的进展,细胞变得未分化,相似性增加。91.3%的原发病例和86.9%的转移性恶性肿瘤存在细胞组织学相关性。结论:密切关注细胞团、核内包涵体、内皮边缘等细胞学特征,结合影像学和生化标志物,为区分原发性HCC和肝转移癌提供了有价值的指标,从而避免了侵入性手术的需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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