Abstract
Sixty-two cases of hepatocellular carcinoma examined cytologically (29 fine-needle aspirates, 28 touch preparations of biopsy or resected specimens, and 5 aspirates or touch preparations of autopsy specimens) were subclassified into four grades (GI-IV) using Edmondson's classification modified for cytodiagnosis and according to several specific types (clear cell, pleomorphic and spindle cell types). In this report cytomorphological characteristics of each grade and specific types of HCC were described.
In G-I HCC, tumor cells were more cohesive than in normal hepatocytes, and were present in sheet or trabecular patterns. They were large, polygonal and uniform with abundant granular eosinophilic cytoplasm. Nuclei with slightly enlarged nucleoli were round and centrally located, and the N/C ratio was slightly higher than that of normal hepatocytes. Cytologic specimens of G-II HCC contained a large number of tumor cells which were present singly or in large clusters. They had most typical features of HCC showing both evdience of hepatocytic origin and of distinct malignancy, that is, granular eosinophilic cytoplasm, enlarged nuclei with prominent nucleoli, and a high N/C ratio. In GIII HCC, evidence of hepatocytic origin was decreased, although malignancy was obvious. Tumor cells were pleomorphic, less cohesive and present singly or in small clusters. The most characteristic feature of this grade was the presence of mono or multinucleated giant cells with abundant cytoplasm and large irregularly shaped hyperchromatic nuclei containing a few prominent nucleolei. In G-IV HCC, evidence of hepatocytic origin was completely absent and tumor cells were cohesive, relatively small and uniform in size and shape. They had scanty cytoplasm and round hyperchromatic nuclei with indistinct nucleoli. The N/C ratio was the highest of the four grades.
Clear cells of specific type contained glycogen and/or lipid, and showed the same nuclear appearance as that of GI or G-II HCC. They resembled tumor cells of renal cell carcinoma in appearance. In the pleomorphic type, although bizarre giant cells were observed, they were much more numerous and larger than those of G-III HCC. Tumor cells of the spindle cell type were large, and present in small clusters. They had vesicular cytoplasm with distinct cell borders and nuclei with indistinct nucleoli, resembling sarcomatous cells.
