Fine needle aspiration cytology of metastatic transitional cell carcinoma to the liver

A 63-year-old man presented with a three-month history of painless hematuria. A cystoscopic examination revealed a diffuse small nodulopapillary growth of the bladder mucosa. Biopsy resulted in the diagnosis of a transitional cell carcinoma (TCC), grade II. Therefore, total cystectomy with an ileal conduit was performed and the pathologic examination demonstrated a TCC grade II/III apparently confined to the mucosa. However, an ultrasonographic study carried out one year later revealed tumor masses in the pelvic cavity and the liver. FNA and needle biopsy of the liver were carried out and the diagnosis of a metastatic TCC was made from the former. Needle biopsy results pointed to a metastatic undifferentiated carcinoma, most likely originating from the TCC. The advantage of FNA is discussed. It is being used with increasing frequency to diagnose mass lesions in the liver and can identify metastatic tumors which have specific cytologic features that are different from primary liver tumor.