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      Unusual reticulin staining pattern in well-differentiated hepatocellular carcinoma

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      1 , , 1 , 1
      Diagnostic Pathology
      BioMed Central

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          Abstract

          Background

          Special stains, such as reticulin stain and CD34 immunostain, are very helpful in the diagnosis of well differentiated hepatocellular carcinoma (HCC). Most studies have shown that absent or decreased reticulin stain or an abnormal reticulin pattern with widened trabeculae is reliable for the diagnosis of well-differentiated HCC.

          Case report

          We report here two cases of well differentiated HCC with an unusual reticulin staining pattern. A strongly positive reticulin network was preserved within the tumor, which surrounded individual tumor cells in a monolayered trabecular pattern. At the same time, an increased CD34 stain was present in the tumor.

          Conclusions

          This unusual reticulin pattern represents part of the diverse reticulin staining patterns seen in HCC. Although this staining pattern is rare, it should be recognized when diagnosing well-differentiated HCC in small samples such as cellblock of fine needle aspiration or small core biopsies.

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          Most cited references11

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          Hepatocellular cancer: a guide for the internist.

          Hepatocellular cancer is the third leading cause of cancer-related deaths worldwide. Its incidence has increased dramatically in the United States because of the spread of hepatitis C virus infection and is expected to increase for the next 2 decades. Hepatitis B virus, hepatitis C virus, and chronic heavy alcohol use leading to cirrhosis of the liver remain the most important causes. The diagnosis of hepatocellular cancer rests on a combination of radiologic, serologic, and histopathologic criteria. Liver transplantation is the only definitive treatment. Resection of the tumor and other percutaneous therapies are more commonly used in practice, because most hepatocellular cancers are detected at an advanced stage. Patients who are at high risk for the development of hepatocellular cancer should be screened with an ultrasound of the liver every 6 months. The prognosis is dependent on both the underlying liver function and the stage at which the tumor is diagnosed. The aim of this review is to familiarize internists in screening, diagnosis, and referral of patients with hepatocellular cancer in an appropriate and timely fashion.
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            Quantitation of sinusoid-like vessels in hepatocellular carcinoma: its clinical and prognostic significance.

            Angiogenesis is crucial for tumor growth and metastasis. Hepatocellular carcinoma (HCC) is a typical hypervascular tumor. However, the relationship between tumor vascularity and the outcome of patients with HCC has not been evaluated. To clarify whether tumor angiogenesis is related to the prognosis of patients, immunohistochemical staining, using anti-von Willebrand factor (vWF) and anti-CD34, was applied in resected specimens from 43 cases of HCC. In nonmalignant tissue, staining was confined to vessels in the portal tract and to a few periportal sinusoids with both of the endothelial markers applied. In tumor tissue, however, sinusoid-like vessels reacted intensively with anti-CD34 but not with anti-vWF. The intratumor microvessel density (MVD) highlighted by anti-CD34 was 297 +/- 88 (per 0.74 mm2), which was significantly higher than that highlighted by anti-vWF (4 +/- 7). When only the MVD highlighted by anti-CD34 was analyzed, tumor diameter larger than 2 cm, poor differentiation (Edmondson's II to IV), and portal invasion were significantly related to the subgroup with MVD > or = 290. Overall survival curves of patients with MVD < 290 were better, and these patients were more likely to remain tumor free. Cox hazards model revealed intratumor MVD and Edmondson's grade to be independent prognostic factors for the overall survival of patients. These results demonstrated for the first time that tumor angiogenesis assessed by anti-CD34 was correlated with the outcome of patients with HCC, suggesting a potential role for anti-CD34 in the diagnosis and treatment of HCC.
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              Proposal for standardized criteria for the diagnosis of benign, borderline, and malignant hepatocellular lesions arising in chronic advanced liver disease.

              Although current literature contains many cases of putative premalignant hepatocellular proliferations and small hepatocellular carcinomas, no consistent nomenclature and diagnostic criteria have been put forward to describe them. These nodules, which are being detected by radiographic techniques in cirrhotic livers and removed during transplantation procedures, represent a new and challenging histologic spectrum of liver pathology. In this study, a multinational panel of five liver pathologists reviewed 23 such nodules and were able to reach a consensus on the diagnostic criteria and to devise a standard nomenclature to describe the histologic lesions. We recommend that benign nodules showing little histologic difference from cirrhotic nodules be classified as regenerative or macroregenerative, and nodules with atypical features not diagnostic of carcinoma be classified as borderline. Such standardization should facilitate further study of the pathologic features and clinical behavior of these lesions.
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                Author and article information

                Journal
                Diagn Pathol
                Diagnostic Pathology
                BioMed Central
                1746-1596
                2011
                22 February 2011
                : 6
                : 15
                Affiliations
                [1 ]Department of Pathology and Laboratory Medicine, Brody School of Medicine at East Carolina University, 600 Moye Boulevard 7S10, Greenville, North Carolina 27858, USA
                Article
                1746-1596-6-15
                10.1186/1746-1596-6-15
                3049127
                21338527
                166d3bcc-7767-488a-b9e5-a066ccf5858a
                Copyright ©2011 Hong et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 4 February 2011
                : 22 February 2011
                Categories
                Case Report

                Pathology
                Pathology

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