Medullary-like hepatocellular carcinoma: an unusual histologic variant

Due to differences in prognosis and management, it is important to subclassify hepatocellular carcinoma (HCC). We encountered an unusual case of HCC with features not typical of the previously described subtypes that was composed of a markedly cellular background consisting of plasma cells and lymphocytes.

Review of the literature revealed a single prior case report describing a lesion with similar histology.

In contrast to the previous case report suggesting a less aggressive course and a lesion with increased apoptotic activity, our patient died as a result of his disease within 30 days of diagnosis. In this report, we compare the features of our case with the previously described lesion and use immunohistochemistry for cleaved caspase 3 to evaluate apoptosis and mismatch repair proteins to evaluate microsatellite instability.

This report is presented to increase awareness of this unusual lesion and because it raises questions regarding the previous claim suggesting a less aggressive clinical course.