Contributed by Lin Liu, MD, PhD and Sara E Monaco, MD
Contributed by Lin Liu, MD, PhD and Sara E Monaco, MD
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CLINICAL HISTORY
An 81-year-old man with a previous history of lymphoma and a gastric mass presented with multiple liver masses. Ultrasound-Guided FNA of a liver mass was performed with on-site cytopathology evaluation (Figures 1-4).
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Figure 1 (Diff-Quik stain; Left. x200 magnification; Right. x400 magnification)
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Figure 2 (Diff-Quik stain; x400 magnification)
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Figure 3 (Papanicolaou stain, x400 magnification)
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Figure 4 (H&E, Pankeratin and C-Kit stains of the cell block)
Cytomorphology
Cytological examination of the aspirate smears from the liver fine needle aspiration (FNA) are cellular and demonstrate loosely cohesive and discohesive epithelioid cells, in a background of benign hepatocytes (Figures 1, 2 and 3). These cells have moderate nuclear pleomorphism, increased nuclear-to-cytoplasmic ratios, and moderate amounts of dense-to-glassy cytoplasm. In addition, there is a conspicuous presence of metachromatic extracellular material intermingled with the cells on the aspirate smears, and most easily visualized on the air-dried Diff-Quik stained smears (Figure 2).
Immunohistochemistry studies
Immunohistochemical stains revealed that the tumor cells are positive for CD117/c-Kit (Figure 4), and negative for Pan-cytokeratin (Figure 4), Vimentin, Smooth muscle actin, S100 and CD34.
