Cytomorphologic and DNA cytometric features of hepatocellular carcinoma in fine needle aspirates

To classify hepatocellular carcinoma according to DNA ploidy patterns and to evaluate distinct cytomorphologic features of hepatocellular carcinoma that correlate with DNA ploidy patterns.

Fine needle aspiration smears of 36 histologically proven hepatocellular carcinomas were performed for DNA measurement by image analysis after Feulgen restaining of the specimens. Nuclear features-prominent nucleoli, nuclear cleavage, nuclear area and nuclear/cytoplasmic ratio-were correlated with the DNA ploidy patterns.

Of the 36 cases, 14 were either diploid (n = 7) or polyploid (n = 7), 19 tumors had a single aneuploid stemline, 2 cases had multiple stemlines, and 1 case had no discernible stemline. A preponderance of prominent nucleoli was seen in 7/7 diploid tumors (2c), 6/7 polyploid tumors (4c, 8c) and 6/8 aneuploid tumors (> 4c). Conspicuous nuclear cleavage in a high number of tumor cells was present substantially in tumors with large nuclear areas (4c, > 4c).

Most hepatocellular carcinoma studied had a distinct stemline so that the tumors could be designated DNA diploid, polyploid or aneuploid. The prevalence of prominent nucleoli and nuclear cleavage was a distinguishing cytologic feature that could predict DNA ploidy patterns. No special association of the nuclear/cytoplasmic ratio with any of the ploidy groups was noted.