Cytomorphological Patterns of Nodular Lesions of Liver

Document Type: Original Research

Authors

1 Dept. of Pathlology, Manipur University, Imphal, India

2 Dept. of Pathlology, Aligargh Muslim University, Imphal, India

3 Depet. Of Medicine, Manipur University, Imphal, India

Abstract

Background and Objectives: Nodular lesions of liver are usually neoplastic (primary or metastatic), although inflammatory lesions can occur. The objectives of this paper were to study the cytomorphological changes in various nodular lesions of liver and to correlate the cytomorphological findings with biochemical parameters especially serum alpha-fetoprotein.
Materials & Methods:  A cross-sectional study consisting of 40 patients with nodular liver lesions was carried out at Regional Institute of Medical Sciences (RIMS) during the period from August 2008 to July 2010 (2 years). A detailed clinical history and relevant data were collected. Fine needle aspiration cytology (FNAC) findings were correlated with clinical and biochemical parameters especially alpha-fetoprotein (AFP). Statistical analyses of the results were done and discussed.
Results: Out of these 40 patients, 28 (70%) were male and 12 (30%) were female with a male female ratio of 2.3:1. Age of the patients ranged from 13 years to 85 years with a mean age of 47.5 yr. Regarding the FNAC diagnosis, 18 cases (45%) were non-neoplastic and 22 cases (55%) were neoplastic. Out of the total 22 malignant lesions, majorities were metastases with 14 cases (63.6%) and 8 cases (36.4%) were hepatocellular carcinoma (HCC). 75% of HCC patients (6 cases) had markedly elevated serum AFP level (> 500 ng/ml). The association of hepatic malignancy with serum alpha-fetoprotein level was found to be statistically significant.
Conclusion: This study emphasized on unique cytomorphological patterns of distinctive liver lesions for the diagnosis by FNAC and importance of the interpretation of FNAC results along with serum alpha-fetoprotein level in the cases of malignancy
 

  1. Junqueira LC, Carneiro J. Organs Associated with the Digestive Tract. Basic Histology. 11th ed. New York: MacGraw Hill; 2011.
  2. Tsui W, Cheng F, Lee Y. Fine needle aspiration cytology of liver tumors. Ann Contemporary Diag Pathol 1998;(2):79-93.
  3. Fletcher C. Diagnostic Histopathology of Tumours. 3rd ed. Philadelphia: Churchill Livingstone; 2007.
  4. Yap SF, Peh SC. Alpha-fetoprotein in hepatocellular carcinoma: a serological and histochemical study in Malaysian patients. Malays J Pathol 1991;13(2):115-8.
  5. Baig JA, Alam JM, Mahmood SR, Baig M, Shaheen R, Sultana I, et al. . Hepatocellular carcinoma (HCC) and diagnostic significance of A-fetoprotein (AFP). J Ayub Med Coll Abbottabad 2009;21(1):72-5.
  6. Koss L, Melamed M. Diagnostic Cytology and Its Histopathologic Bases. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.
  7. Ji XL. Fine-needle aspiration cytology of liver diseases. World J Gastroenterol 1999;5(2):95-7.
  8. 8.         Orell S, Sterrett G, Whitaker D, Leiman G. Liver   and   Spleen. Fine Needle Aspiration Cytology. 4 ed. New Delhi: Elseiver; 2005.
  9. Patel AB, Prabhu AS, Dibley MJ, Kulkarni LR. A tool for rapid socioeconomic assessment. Indian J Pediatr 2007;74(4):349-52.
  10. Rasania A, Pandey C, Joshi N. Evaluation of FNAC in diagnosis of hepatic lesion. J Cytol 2007;24(1):51-4.
  11. Nggada HA, Ajayi NA, Ahidjo A, Pindiga UH, Tahir A, Mustapha SK, et al. . Fine needle aspiration cytology diagnosis of liver diseases in the University of Maiduguri Teaching Hospital, Maiduguri. Afr J Med Med Sci 2004 Sep;33(3):255-7.
  12. Hao XS, Chen KX, Wang PP, Rohan T. Changes in survival patterns in urban Chinese patients with liver cancer. World J Gastroenterol 2003;9(6):1212-5.
  13. Talukder SI, Huq MH, Haque MA, Rahman S, Islam SM, Hossain GA, et al. . Ultrasound guided fine needle aspiration cytology for diagnosis of mass lesions of liver. Mymensingh Med J 2004;13(1):25-9.
  14. Sobhonslidsuk A, Silpakit C, Kongsakon R, Satitpornkul P, Sripetch C, Khanthavit A. Factors influencing health-related quality of life in chronic liver disease. World J Gastroenterol 2006 Dec 28;12(48):7786-91.
  15. Cohen MB, Haber MM, Holly EA, Ahn DK, Bottles K, Stoloff AC. Cytologic criteria to distinguish hepatocellular carcinoma from nonneoplastic liver. Am J Clin Pathol 1991;95(2):125-30.
  16. Assy N, Nasser G, Djibre A, Beniashvili Z, Elias S, Zidan J. Characteristics of common solid liver lesions and recommendations for diagnostic workup. World J Gastroenterol 2009 Jul 14;15(26):3217-27.
  17. Bahirwani R, Reddy KR. Review article: the evaluation of solitary liver masses. Aliment Pharmacol Ther 2008 Oct 15;28(8):953-65.
  18. Tchelepi H, Ralls PW, Radin R, Grant E. Sonography of diffuse liver disease. J Ultrasound Med 2002;21(9):1023-32.
  19. Gatphoh ED, Gaytri S, Babina S, Singh AM. Fine needle aspiration cytology of liver: a study of 202 cases. Indian J Med Sci 2003;57(1):22-5.
  20. Roy M, Bhattacharyya A, Dasgupta S, Sanyal S. Fallacies of the fine needle aspiration cytology of surgical lesions of liver. J Indian Med Assoc 1994;92(9):285-7, 290.
  21. Mondal A. Cytodiagnostic accuracy of hepatic malignancy by fine needle aspiration biopsy. J Indian Med Assoc 1991;89(8):222-4.
  22. Ahuja A, Gupta N, Srinivasan R, Kalra N, Chawla Y, Rajwanshi A. Differentiation of hepatocellular carcinoma from metastatic carcinoma of the liver – clinical and cytological features. J Cytol 2007 Oct 5;24(3):125-9.
  23. Kung IT, Chan SK, Fung KH. Fine-needle aspiration in hepatocellular carcinoma. Combined cytologic and histologic approach. Cancer 1991 Feb 1;67(3):673-80.
  24. Soyuer I, Ekinci C, Kaya M, Genc Y, Bahar K. Diagnosis of hepatocellular carcinoma by fine needle aspiration cytology. Cellular features. Acta Cytol 2003;47(4):581-9.
  25. Das DK, Tripathi RP, Kumar N, Chachra KL, Sodhani P, Parkash S, et al. . Role of guided fine needle aspiration cytology in diagnosis and classification of liver malignancies. Trop Gastroenterol 1997;18(3):101-6.
  26. Bottles K, Cohen MB. An approach to fine-needle aspiration biopsy diagnosis of hepatic masses. Diagn Cytopathol 1991;7(2):204-10.
  27. Thapa BR, Walia A. Liver function tests and their interpretation. Indian J Pediatr 2007;74(7):663-71.