Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021;37(3):196-202.
doi: 10.5146/tjpath.2021.01527.

The Role of Immunocytochemical Markers to Differentiate Primary from Secondary Neoplastic Hepatic Masses: A Diagnostic Challenge on Cytology

Jenna B Bhattacharya  1 , Shyam Lata Jain, Subbarayan Devi
Affiliations

The Role of Immunocytochemical Markers to Differentiate Primary from Secondary Neoplastic Hepatic Masses: A Diagnostic Challenge on Cytology

Jenna B Bhattacharya et al. Turk Patoloji Derg. 2021.

Abstract

Objective: It is challenging and difficult to differentiate primary from metastatic hepatic masses solely on cytology. The present study aimed to correlate cytomorphological spectrum of hepatic masses with immunocytochemical markers to differentiate primary from metastases in liver.

Material and method: The present study comprised of 30 clinico-radiologically suspicious cases of neoplastic hepatic masses. Ultrasound-guided fine needle aspiration smears and cell blocks were prepared as per standard technique; two of the smears were air-dried and Giemsa stained to study cytomorphological features. A panel of markers (HepPar-1, CD 10, CK7, CK19, CD34, and MOC-31) were studied both in smears and cell blocks.

Results: Cytomorphological features on smears were evaluated and correlated with immunocytochemistry in all cases; the final diagnosis was: Hepatocellular carcinoma (n=7), cholangiocarcinoma (n=2), hepatoblastoma (n=1) and metastatic carcinoma (n=20). HepPar-1, CD10 and CD34 demonstrated 86%, 72%, 86% sensitivity and 100% specificity respectively for hepatocellular carcinoma; CK7&CK19 showed 100% sensitivity for cholangiocarcinoma, MOC 31 showed 90% sensitivity and 100% specificity for metastatic carcinoma.

Conclusion: The present study recommends a panel of minimum three markers (HepPar-1, CD10, and MOC-31) which were helpful to differentiate hepatocellular carcinoma from metastatic carcinoma that was a major diagnostic challenge solely on cytomorphology. Correlating cytomorphology with these three markers, 100% of the cases could be diagnosed as primary malignancy and distinguished accurately from metastatic carcinoma.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A) CT image showing a single spaceoccupying lesion. B) CT image showing multiple space-occupying lesions suggesting metastases. C) FNA smears showing atypical cells with perivascular arrangement, scattered naked nuclei (Giemsa; x400). D) Well-differentiated HCC showing trabecular arrangement (Giemsa; x400). Figure insets: HepPar-1 showing strong granular cytoplasmic positivity (ICC; x400). CD10 showing strong granular cytoplasmic positivity (ICC; x400). CD34 showing strong grade 3 positivity (ICC; x400).
Figure 2
Figure 2
A-B) Cholangiocarcinoma showing atypical columnar cells in an acinar pattern with a fibrotic background (Giemsa; x400). C) CK7 showing strong cytoplasmic positivity in tumor cells (ICC; x400). D) CK19 showing strong cytoplasmic positivity in tumor cells (ICC; x400). (Inset: Tumor cells negative for Hep Par 1).
Figure 3
Figure 3
Metastatic adenocarcinoma. A) Atypical cells with intracytoplasmic mucin in a necrotic background (Giemsa; x400). B) MOC31 showing strong membranous accentuation in A B tumor cells (ICC; x400).
See this image and copyright information in PMC

References

    1. Yadav Rajni, Chopra Saurav, Garg Aayushi, Gupta Brijnandan, Kinra Prateek, Gupta Siddhartha Datta, Das Prasenjit. Does Hepatocyte Paraffin 1 expression stand a role in determining the site origin of an adenocarcinoma from unknown gastrointestinal primary? Dec;2016 Indian J Pathol Microbiol. 59:474–480. doi: 10.4103/0377-4929.191781. - DOI - PubMed
    1. Proca D. M., Niemann T. H., Porcell A. I., DeYoung B. R. MOC31 immunoreactivity in primary and metastatic carcinoma of the liver. Report of findings and review of other utilized markers. Jun;2000 Appl Immunohistochem Mol Morphol. 8:120–125. doi: 10.1097/00129039-200006000-00006. - DOI - PubMed
    1. Lin Fan, Abdallah Heba, Meschter Steven. Diagnostic utility of CD10 in differentiating hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration biopsy (FNAB) of the liver. Feb;2004 Diagn Cytopathol. 30:92–97. doi: 10.1002/dc.10419. - DOI - PubMed
    1. Saad Reda S., Luckasevic Todd M., Noga Christine M., Johnson Douglas R., Silverman Jan F., Liu Yulin L. Diagnostic value of HepPar1, pCEA, CD10, and CD34 expression in separating hepatocellular carcinoma from metastatic carcinoma in fine-needle aspiration cytology. Jan;2004 Diagn Cytopathol. 30:1–6. doi: 10.1002/dc.10345. - DOI - PubMed
    1. Singha Joydeb, Khan Kalyan, Chatterjee Souvik. Diagnostic utility of CD10 immunohistochemical staining on cellblock in differentiating hepatocellular carcinoma from secondary malignancies of liver. Dec;2018 Indian J Pathol Microbiol. 61:510–515. doi: 10.4103/IJPM.IJPM_788_16. - DOI - PubMed