Comparison of morphologic features of benign hepatocytes associated with nonmalignant and malignant liver lesions

In fine needle aspirates (FNAs) of focal liver lesions, the absence of neoplastic cells and presence of hepatocytes with prominent reactive changes often raise the question of whether the lesion was adequately sampled or whether the aspirate represents an area adjacent to the neoplasm. To study this problem we reviewed 51 FNAs of focal liver lesions: 29 metastatic deposits, 4 primary malignancies and 18 nonneoplastic lesions. Fifteen cytologic features were scored on a scale of 0-3 by two independent observers using conventional light microscopy. Hepatocytes in 18 aspirates of nonneoplastic lesions showed considerable degrees of cytoplasmic vacuolation, nuclear enlargement, cytoplasmic pigmentation, binucleation, anisonucleosis and intranuclear inclusions. In contrast, hepatocytes in 29 aspirates of metastatic deposits displayed a considerably lower degree of some of these features (cytoplasmic pigment, binucleation, anisonucleosis and nuclear enlargement.) The four aspirates of hepatocellular carcinoma showed nuclear enlargement of hepatocytes comparable to that in the nonmalignant aspirates; other accompanying features, however, were less conspicuous. We conclude that marked cytologic alterations in hepatocytes are seen most frequently in FNAs of nonneoplastic liver lesions, such as focal nodular hyperplasia, cirrhosis, abscess and hepatitis, and that hepatocytes accompanying metastatic deposits typically show less-pronounced cytologic alterations.