Clear cell hepatocellular carcinoma diagnosed by bile duct brushing cytology

Clear cell hepatocellular carcinoma (CCHCC) is an uncommon morphologic variant of HCC and rarely invades into the main bile ducts. Here we describe a case of CCHCC that was diagnosed by bile duct brushing cytology. Liquid-based preparation of brushing specimen showed clusters of atypical epithelial cells with abundant clear cytoplasm, round nuclei, and occasional intranuclear inclusions. The tumor cells were positive for HepPar-1 and arginase 1, suggestive of their hepatic origin. The overall morphologic and immunophenotypic features were consistent with CCHCC. The cytological diagnosis was confirmed by histopathologic examination of the resected tumor.