Fine needle aspiration diagnosis of hepatocellular carcinoma in metastatic sites

To describe the fine needle aspiration (FNA) findings in metastatic hepatocellular carcinoma (HCC).

The cytologic findings in 15 cases of extrahepatic metastatic HCC diagnosed by FNA biopsy were reviewed.

The anatomic sites of the FNAs were: musculoskeletal (four biopsies from 3 patients), adrenal (4 patients), regional lymph nodes (4 patients), pancreas (2 patients) and pelvic region (1 patient). The 15 aspirates came from 14 patients, 11 of whom had a biopsy-proven primary HCC. In two of the remaining patients, the FNA diagnosis of HCC in the metastatic site was the initial diagnosis. In one of these patients the diagnosis was strongly suspected on clinical grounds, but in the other case it was unsuspected. In the remaining patient the liver mass and massive retroperitoneal adenopathy were biopsied concurrently. A trabecular pattern was observed in the smears and/or cell block preparations in nine cases. Eleven cases were well to moderately differentiated. Three cases were of large cell pleomorphic type. The remaining case was poorly differentiated.

Familiarity with the FNA cytology of HCC should allow its diagnosis in metastatic sites in most instances, even without a history of primary liver cancer.