Non-gynaecological Cytology
Liver cytology
Anatomy and histology of the liver
Fine needle aspiration (FNA)
Normal cells
Infections
Benign lesions
Malignant tumors

Cirrhosis

Cirrhosis, whether caused by alcoholic hepatitis, viral hepatitis or other diseases, results in a disruption of the normal liver architecture, with bands of fibrosis separating nodules of regenerating hepatocytes. Some nodules can be larger and raise the suspicious of a malignancy, such as hepatocellular carcinoma. As a matter of fact, patients with cirrhosis are at increased risk for developing hepatocellular carcinoma. Patients with a focal lesion in the setting of cirrhosis are often biopsied with FNA, although accuracy may be higher with needle biopsy.

Cytologic diagnostic features

  • Normal-appearing hepatocytes, sometimes with steatosis
  • Focal atypia in some cases (marked variation in nuclear size, prominent nucleoli, binucleation)

Differential diagnosis

  • Hepatocellular carcinoma
  • Hepatic adenoma
  • Focal nodular hyperplasia
  • Normal liver
  • Nodular regenerative hyperplasia (nodular transformation of the liver)

When hepatocyte atypia is due to cirrhosis, smears show a spectrum ranging from normal to markedly atypical hepatocytes, whereas smears from a hepatocellular carcinoma are usually monomorphic. In hepatocellular carcinoma, other diagnostic features are an increased N/C ratio, a trabecular arrangement of hepatocytes surrounded by endothelial cells, and atypical naked nuclei. The different benign conditions are cytologically indistinguishable and the diagnosis rests on clinical-pathologic correlation.


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