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Presented by Pedram Argani, MD and prepared by Armen Khararjian, MD
Case 1: This is a 75 year old female with a solitary lung mass.
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Question 1 of 1
1. Question
Week 609: Case 1
This is a 75 year old female with a solitary lung mass.
Correct
Answer: Hepatocellular Carcinoma
Histology:
This is a nested epithelioid proliferation with a sinusoidal capillary vasculature. The neoplastic cells have sharp crisp cell borders, which simulates that of a primary squamous cell carcinoma at the lung. However, there is no evidence of keratinization, and the sinusoidal vasculature pattern is not typical of squamous cell carcinoma. This patient had a prior history of hepatocellular carcinoma, and the current neoplasm labeled with arginase 1 and glypican 3, which supports the diagnosis of metastatic hepatocellular carcinoma.Discussion:
Differential Diagnosis: Squamous cell carcinoma would demonstrate intercellular bridges, and would label for high molecular cytokeratin but not arginase 1. Pulmonary adenocarcinoma would typically label for TTF-1 and not arginase
1. Small cell carcinoma would feature small round blue cells with high nucleus to cytoplasm ratio, nuclear molding, high mitotic rate and necrosis.Arginase 1 is likely the best marker hepatocellular carcinoma, in that it is more sensitive than specific than HepPar 1 or glypican 3. HepPar 1 has diminished sensitivity in that it misses poorly differentiated hepatocellular carcinomas, and also lacks specificity in that it frequently stains other carcinomas of foregut origin (such as gastric, colon, and pancreatobiliary adenocarcinomas). Glypican 3 can be negative in well differentiated hepatocellular carcinomas, also stains yolk sac tumors, and may stain other carcinomas and melanoma.
Incorrect
Answer: Hepatocellular Carcinoma
Histology:
This is a nested epithelioid proliferation with a sinusoidal capillary vasculature. The neoplastic cells have sharp crisp cell borders, which simulates that of a primary squamous cell carcinoma at the lung. However, there is no evidence of keratinization, and the sinusoidal vasculature pattern is not typical of squamous cell carcinoma. This patient had a prior history of hepatocellular carcinoma, and the current neoplasm labeled with arginase 1 and glypican 3, which supports the diagnosis of metastatic hepatocellular carcinoma.Discussion:
Differential Diagnosis: Squamous cell carcinoma would demonstrate intercellular bridges, and would label for high molecular cytokeratin but not arginase 1. Pulmonary adenocarcinoma would typically label for TTF-1 and not arginase
1. Small cell carcinoma would feature small round blue cells with high nucleus to cytoplasm ratio, nuclear molding, high mitotic rate and necrosis.Arginase 1 is likely the best marker hepatocellular carcinoma, in that it is more sensitive than specific than HepPar 1 or glypican 3. HepPar 1 has diminished sensitivity in that it misses poorly differentiated hepatocellular carcinomas, and also lacks specificity in that it frequently stains other carcinomas of foregut origin (such as gastric, colon, and pancreatobiliary adenocarcinomas). Glypican 3 can be negative in well differentiated hepatocellular carcinomas, also stains yolk sac tumors, and may stain other carcinomas and melanoma.
