Granuloma rich hepatocellular carcinoma (GrHCC): Clinicopathologic and genomic characterization

There is limited literature on sarcoid like granuloma (SLG) associated with hepatocellular carcinoma (HCC). Here in, we studied clinicopathological characteristics, and explored the potential significance of SLG in HCC. We termed these tumors as granuloma rich HCC (GrHCC). We reviewed clinicopathologic features in 30 GrHCC tumors that were diagnosed in 21 patients during a period of 68-month at a single institution. The study included 17 males and 4 females, with ages ranging from 43 to 71 years in males and 20 to 69 years in females. Tumor downstaging was done in 4 patients. Tumor sizes ranged from 0.6 to 23 cm, with a mean size of 2.41 cm. Majority of tumors showed well to moderate cellular differentiation. A solitary well-formed epithelioid granuloma sufficed to classify the tumor as GrHCC. The intratumoral granulomas were compact, well-formed, and discrete, consisting of collections of epithelioid histiocytes and multinucleate histiocytic giant cells. Mild lymphocytic inflammation was also noted. Single to several granulomas were identified in the tumor. Size of granuloma ranged from 170 to 650 μm. Only one tumor showed necrotizing granulomas. Genomic analysis of 4 tumors revealed TP53 mutation. Two tumors also exhibited a TERT promoter mutation. All patients were alive till last follow-up, except for one, who died due to septic shock, unrelated to the HCC. This study provides valuable insights into the clinical findings, histopathological features and molecular characteristics of GrHCC.