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Atlas of Cytopathology and Radiology pp 7–28Cite as

Liver

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Abstract

The main indication for fine-needle aspiration (FNA) biopsy of the liver is the diagnosis of localized disease by imaging studies, including hepatocellular carcinoma (HCC) and metastatic neoplasms from either a known or unknown primary tumor. The overall sensitivity, specificity, and accuracy of FNA in the diagnosis of malignant lesions is 92% to 96%, 92% to 100%, and 96%, respectively. Sensitivity of FNA to differentiate HCC from metastatic tumors in the liver is approximately 96%, with a specificity of 100% and a diagnostic accuracy of 97.5%. FNA of benign liver lesions poses an increased diagnostic challenge. Aspiration of cystic lesions, which is less frequently performed, can help in detecting a possible neoplastic origin of the cyst or accompanying microorganisms. As imaging studies have improved, FNA has become less useful for diagnosis of hepatitis and cirrhosis. Moreover, differentiation between cirrhosis and benign hepatocellular lesions (i.e., regenerative nodules) by FNA remains difficult.

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References

  1. Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. Liver. In: Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A, editors. Modern cytopathology. London: Churchill Livingstone, Elsevier; 2004. p. 505–42.

    Google Scholar 

  2. Nazir RT, Sharif MA, Iqbal M, Amin MS. Diagnostic accuracy of fine needle aspiration cytology in hepatic tumours. J Coll Physicians Surg Pak. 2010;20:373–6.

    PubMed  Google Scholar 

  3. Conrad R, Castelino-Prabhu S, Cobb C, Raza A. Cytopathologic diagnosis of liver mass lesions. J Gastrointest Oncol. 2013;4:53–61.

    PubMed  PubMed Central  Google Scholar 

  4. Wee A. Fine-needle aspiration biopsy of hepatocellular carcinoma and related hepatocellular nodular lesions in cirrhosis: controversies, challenges, and expectations. Pathol Res Int. 2011;2011:587936.

    Article  Google Scholar 

  5. Wang P, Meng ZQ, Chen Z, Lin JH, Ping B, Wang LF, et al. Diagnostic value and complications of fine needle aspiration for primary liver cancer and its influence on the treatment outcome—a study based on 3011 patients in China. Eur J Surg Oncol. 2008;34:541–6.

    Article  CAS  PubMed  Google Scholar 

  6. Livraghi T, Damascelli B, Lombardi C, Spagnoli I. Risk in fine-needle abdominal biopsy. J Clin Ultrasound. 1983;11:77–81.

    Article  CAS  PubMed  Google Scholar 

  7. Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology. 1991;178:253–8.

    Article  CAS  PubMed  Google Scholar 

  8. Tyagi R, Dey P. Needle tract seeding: an avoidable complication. Diagn Cytopathol. 2014;42:636–40.

    Article  PubMed  Google Scholar 

  9. Jurczyk MF, Zhu B, Villa C, DeFrias D, Lin X. Cytomorphology of intraductal oncocytic papillary neoplasm of the liver. Diagn Cytopathol. 2014;42:895–8.

    Article  PubMed  Google Scholar 

  10. Agarwal PK, Husain N, Singh BN. Cytologic findings in aspirated hydatid fluid. Acta Cytol. 1989;33:652–4.

    CAS  PubMed  Google Scholar 

  11. Mettler FA, Guiberteau MJ. Essentials of nuclear medicine imaging. 5th ed. Philadelphia: W.B. Saunders; 2005.

    Google Scholar 

  12. Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007;45:284–93.

    Article  CAS  PubMed  Google Scholar 

  13. Johnson CD, Schmit GD. Mayo Clinic gastrointestinal imaging review. Rochester: Mayo Clinic; 2005.

    Google Scholar 

  14. Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK. CT and MR imaging of benign hepatic and biliary tumors. Radiographics. 1999;19:431–51.

    Article  CAS  PubMed  Google Scholar 

  15. Zeppa P, Anniciello A, Vetrani A, Palombini L. Fine needle aspiration biopsy of hepatic focal fatty change. A report of two cases. Acta Cytol. 2002;46:567–70.

    Article  PubMed  Google Scholar 

  16. Anstee QM, McPherson S, Day CP. How big a problem is non-alcoholic fatty liver disease? BMJ. 2011;343:d3897.

    Article  PubMed  Google Scholar 

  17. Takeshita A, Yamamoto K, Fujita A, Hanafusa T, Yasuda E, Shibayama Y. Focal hepatic steatosis surrounding a metastatic insulinoma. Pathol Int. 2008;58:59–63.

    Article  CAS  PubMed  Google Scholar 

  18. Tani M, Yamaue H, Oka M, Onishi H, Kinoshita H, Hirabayashi N, et al. Focal fatty liver after pancreaticoduodenectomy: a case report of a rare entity of intrahepatic tumor. Hepato-Gastroenterology. 2002;49:1087–9.

    PubMed  Google Scholar 

  19. Gong L, Su Q, Zhang W, Li AN, Zhu SJ, Feng YM. Liver cell adenoma: a case report with clonal analysis and literature review. World J Gastroenterol. 2006;12:2125–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol. 2000;33:282–9.

    Article  CAS  PubMed  Google Scholar 

  21. Sookoian S, Castano GO, Burgueno AL, Gianotti TF, Rosselli MS, Pirola CJ. The nuclear receptor PXR gene variants are associated with liver injury in nonalcoholic fatty liver disease. Pharmacogenet Genom. 2010;20:1–8.

    Article  CAS  Google Scholar 

  22. Tebala GD, Jwad A, Khan AQ, Long E, Sissons G. Multifocal nodular fatty infiltration of the liver: a case report of a challenging diagnostic problem. Am J Case Rep. 2016;17:196–202.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB. Fatty liver: imaging patterns and pitfalls. Radiographics. 2006;26:1637–53.

    Article  PubMed  Google Scholar 

  24. Terriff BA, Gibney RG, Scudamore CH. Fatality from fine-needle aspiration biopsy of a hepatic hemangioma. Am J Roentgenol. 1990;154:203–4.

    Article  CAS  Google Scholar 

  25. Davies R. Haemorrhage after fine-needle aspiration biopsy of an hepatic haemangioma. Med J Aust. 1993;158:364.

    CAS  PubMed  Google Scholar 

  26. Reddy KR, Kligerman S, Levi J, Livingstone A, Molina E, Franceschi D, et al. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg. 2001;67:173–8.

    CAS  PubMed  Google Scholar 

  27. Hertzanu Y, Peiser J, Zirkin H. Massive bleeding after fine needle aspiration of liver angiosarcoma. Gastrointest Radiol. 1990;15:43–6.

    Article  CAS  PubMed  Google Scholar 

  28. Choi BY, Nguyen MH. The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol. 2005;39:401–12.

    Article  PubMed  Google Scholar 

  29. Trotter JF, Everson GT. Benign focal lesions of the liver. Clin Liver Dis. 2001;5:17–42.

    Article  CAS  PubMed  Google Scholar 

  30. Buell JF, Tranchart H, Cannon R, Dagher I. Management of benign hepatic tumors. Surg Clin North Am. 2010;90:719–35.

    Article  PubMed  Google Scholar 

  31. Matos AP, Velloni F, Ramalho M, AlObaidy M, Rajapaksha A, Semelka RC. Focal liver lesions: practical magnetic resonance imaging approach. World J Hepatol. 2015;7:1987–2008.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Layfield LJ, Mooney EE, Dodd LG. Not by blood alone: diagnosis of hemangiomas by fine-needle aspiration. Diagn Cytopathol. 1998;19:250–4.

    Article  CAS  PubMed  Google Scholar 

  33. Guy CD, Yuan S, Ballo MS. Spindle-cell lesions of the liver: diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol. 2001;25:94–100.

    Article  CAS  PubMed  Google Scholar 

  34. Iannaccone R, Federle MP, Brancatelli G, Matsui O, Fishman EK, Narra VR, et al. Peliosis hepatis: spectrum of imaging findings. Am J Roentgenol. 2006;187:W43–52.

    Article  Google Scholar 

  35. Chute DJ, Sarti M, Atkins KA. Liver cytology. Cancer Treat Res. 2014;160:83–109.

    Article  PubMed  Google Scholar 

  36. Horta G, Lopez M, Dotte A, Cordero J, Chesta C, Castro A, et al. Benign focal liver lesions detected by computed tomography: review of 1,184 examinations. Rev Med Chil. 2015;143:197–202.

    Article  PubMed  Google Scholar 

  37. Hussain SM, Terkivatan T, Zondervan PE, Lanjouw E, de Rave S, Ijzermans JN, et al. Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics. 2004;24:3–17; discussion, 8–9.

    Article  PubMed  Google Scholar 

  38. Nguyen BN, Flejou JF, Terris B, Belghiti J, Degott C. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol. 1999;23:1441–54.

    Article  CAS  PubMed  Google Scholar 

  39. Makhlouf HR, Abdul-Al HM, Goodman ZD. Diagnosis of focal nodular hyperplasia of the liver by needle biopsy. Hum Pathol. 2005;36:1210–6.

    Article  PubMed  Google Scholar 

  40. Jeong YY, Yim NY, Kang HK. Hepatocellular carcinoma in the cirrhotic liver with helical CT and MRI: imaging spectrum and pitfalls of cirrhosis-related nodules. Am J Roentgenol. 2005;185:1024–32.

    Article  Google Scholar 

  41. Chou R, Cuevas C, Fu R, Devine B, Wasson N, Ginsburg A, et al. Imaging techniques for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Ann Intern Med. 2015;162:697–711.

    Article  PubMed  Google Scholar 

  42. Lewandowski RJ, Sato KT, Atassi B, Ryu RK, Nemcek AA Jr, Kulik L, et al. Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol. 2007;30:571–92.

    Article  PubMed  Google Scholar 

  43. Yang GC, Yang GY, Tao LC. Cytologic features and histologic correlations of microacinar and microtrabecular types of well-differentiated hepatocellular carcinoma in fine-needle aspiration biopsy. Cancer. 2004;102:27–33.

    Article  PubMed  Google Scholar 

  44. Wee A, Nilsson B. Highly well differentiated hepatocellular carcinoma and benign hepatocellular lesions. Can they be distinguished on fine needle aspiration biopsy? Acta Cytol. 2003;47:16–26.

    Article  PubMed  Google Scholar 

  45. Renshaw AA, Haja J, Wilbur DC, Miller TR. Fine-needle aspirates of hepatocellular carcinoma that are misclassified as adenocarcinoma: correlating cytologic features and performance in the College of American Pathologists Nongynecologic Cytology Program. Arch Pathol Lab Med. 2006;130:19–22.

    PubMed  Google Scholar 

  46. Pittman ME, Brunt EM. Anatomic pathology of hepatocellular carcinoma: histopathology using classic and new diagnostic tools. Clin Liver Dis. 2015;19:239–59.

    Article  PubMed  Google Scholar 

  47. Soyuer I, Ekinci C, Kaya M, Genc Y, Bahar K. Diagnosis of hepatocellular carcinoma by fine needle aspiration cytology. Cellular features. Acta Cytol. 2003;47:581–9.

    Article  PubMed  Google Scholar 

  48. Kulesza P, Torbenson M, Sheth S, Erozan YS, Ali SZ. Cytopathologic grading of hepatocellular carcinoma on fine-needle aspiration. Cancer. 2004;102:247–58.

    Article  PubMed  Google Scholar 

  49. Nassar A, Cohen C, Siddiqui MT. Utility of glypican-3 and survivin in differentiating hepatocellular carcinoma from benign and preneoplastic hepatic lesions and metastatic carcinomas in liver fine-needle aspiration biopsies. Diagn Cytopathol. 2009;37:629–35.

    Article  CAS  PubMed  Google Scholar 

  50. Porcell AI, De Young BR, Proca DM, Frankel WL. Immunohistochemical analysis of hepatocellular and adenocarcinoma in the liver: MOC31 compares favorably with other putative markers. Mod Pathol. 2000;13:773–8.

    Article  CAS  PubMed  Google Scholar 

  51. Crowe A, Knight CS, Jhala D, Bynon SJ, Jhala NC. Diagnosis of metastatic fibrolamellar hepatocellular carcinoma by endoscopic ultrasound-guided fine needle aspiration. Cytojournal. 2011;8:2.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Torbenson M. Review of the clinicopathologic features of fibrolamellar carcinoma. Adv Anat Pathol. 2007;14:217–23.

    Article  PubMed  Google Scholar 

  53. Ichikawa T, Federle MP, Grazioli L, Madariaga J, Nalesnik M, Marsh W. Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases. Radiology. 1999;213:352–61.

    Article  CAS  PubMed  Google Scholar 

  54. Perez-Guillermo M, Masgrau NA, Garcia-Solano J, Sola-Perez J, de Agustin y de Agustin P. Cytologic aspect of fibrolamellar hepatocellular carcinoma in fine-needle aspirates. Diagn Cytopathol. 1999;21:180–7.

    Article  CAS  PubMed  Google Scholar 

  55. Sergi CM. Hepatocellular carcinoma, fibrolamellar variant: diagnostic pathologic criteria and molecular pathology update. A primer. Diagnostics (Basel). 2015;6. https://www.ncbi.nlm.nih.gov/pubmed/?term=Sergi+CM.+Hepatocellular+carcinoma%2C+fibrolamellar+variant%3A

  56. Singh HK, Silverman JF, Geisinger KR. Fine-needle aspiration cytomorphology of clear-cell hepatocellular carcinoma. Diagn Cytopathol. 1997;17:306–10.

    Article  CAS  PubMed  Google Scholar 

  57. Chung YE, Kim MJ, Park YN, Choi JY, Pyo JY, Kim YC, et al. Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics. 2009;29:683–700.

    Article  PubMed  Google Scholar 

  58. Jurczyk M, Zhu B, Laskin W, Lin X. Pitfalls in the diagnosis of hepatic epithelioid hemangioendothelioma by FNA and needle core biopsy. Diagn Cytopathol. 2014;42:516–20.

    Article  PubMed  Google Scholar 

  59. Rasalkar DD, Chu WC, Cheng FW, Hui SK, Ling SC, Li CK. A pictorial review of imaging of abdominal tumours in adolescence. Pediatr Radiol. 2010;40:1552–61.

    Article  PubMed  Google Scholar 

  60. Weir EG, Ali SZ. Hepatoblastoma: cytomorphologic characteristics in serious cavity fluids. Cancer. 2002;96:267–74.

    Article  PubMed  Google Scholar 

  61. Iyer VK, Kapila K, Agarwala S, Verma K. Fine needle aspiration cytology of hepatoblastoma. Recognition of subtypes on cytomorphology. Acta Cytol. 2005;49:355–64.

    Article  PubMed  Google Scholar 

  62. Viswanathan S, George S, Ramadwar M, Medhi S, Arora B, Kurkure P. Evaluation of pediatric abdominal masses by fine-needle aspiration cytology: a clinicoradiologic approach. Diagn Cytopathol. 2010;38:15–27.

    PubMed  Google Scholar 

  63. Singh V, Manalang M, Singh M, Apte U. A brief report of immunohistochemical markers to identify aggressive hepatoblastoma. Appl Immunohistochem Mol Morphol. 2017:1. https://doi.org/10.1097/PAI.0000000000000492. [Epub ahead of print.].

  64. Yu RS, Chen Y, Jiang B, Wang LH, Xu XF. Primary hepatic sarcomas: CT findings. Eur Radiol. 2008;18:2196–205.

    Article  PubMed  Google Scholar 

  65. Lin CF, DeFrias D, Lin X. Epithelioid angiosarcoma: a neoplasm with potential diagnostic challenges. Diagn Cytopathol. 2010;38:154–8.

    PubMed  Google Scholar 

  66. Lin X, Saad RS, Luckasevic TM, Silverman JF, Liu Y. Diagnostic value of CDX-2 and TTF-1 expressions in separating metastatic neuroendocrine neoplasms of unknown origin. Appl Immunohistochem Mol Morphol. 2007;15:407–14.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Northwestern University, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA

    Xiaoqi Lin

  2. Department of Pathology, Northwestern Memorial Hospital, McGaw Medical Center, Chicago, IL, USA

    Brandon A. Umphress

  3. Department of Radiology, Monmouth Medical Center, Shrewsbury, NJ, USA

    Ernest F. Wiggins III

  4. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ramona Gupta & Albert A. Nemcek Jr.

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  1. Xiaoqi Lin
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  2. Brandon A. Umphress
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  3. Ernest F. Wiggins III
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  4. Ramona Gupta
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  5. Albert A. Nemcek Jr.
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Correspondence to Xiaoqi Lin .

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Editors and Affiliations

  1. Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA

    Ritu Nayar

  2. Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA

    Xiaoqi Lin

  3. Northshore Medical Group, Evanston Hospital, Evanston, IL, USA

    Ajit S. Paintal

  4. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Ramona Gupta

  5. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Albert A. Nemcek Jr.

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Lin, X., Umphress, B.A., Wiggins, E.F., Gupta, R., Nemcek, A.A. (2020). Liver. In: Nayar, R., Lin, X., Paintal, A., Gupta, R., Nemcek Jr., A. (eds) Atlas of Cytopathology and Radiology. Springer, Cham. https://doi.org/10.1007/978-3-030-24756-0_2

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  • DOI: https://doi.org/10.1007/978-3-030-24756-0_2

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