1. Chapter 14
Hepatic Tumors, Malignant 1
Hepatocellular carcinoma, well-to-moderately differentiated with pseudogland formation
Case 14.6

2. Clinical Presentation14
Hepatic Tumors, Malignant 2
Clinical Presentation
A 75-year-old man with Child-Pugh class A cirrhosis secondary to chronic hepatitis C was found during screening to have a liver mass in the left lobe.
CT scan showed a 3.6 cm arterially enhancing lesion with washout in the left lateral segment, without signs of extrahepatic disease or vascular invasion.
Tumor resection was performed.

3. 14
Hepatic Tumors, Malignant 3
Pathology
The tumor was partially encapsulated, soft and yellow, measuring 3.5 × 3.2 × 3.6 cm.
Moderately differentiated cells forming trabeculae and variably sized pseudoglands were seen (a).
Figure 14.6(a)

4. 14
Hepatic Tumors, Malignant 4
Pathology
Higher power showed many of the pseudoglands to contain bile within the lumen (b).
Figure 14.6(b)

5. 14
Hepatic Tumors, Malignant 5
Pathology
Variable steatosis and lymphocytic infiltrates were also seen elsewhere in the tumor (c).
Figure 14.6(c)

6. 14
Hepatic Tumors, Malignant 6
Diagnosis
Hepatocellular carcinoma, well-to-moderately differentiated with pseudogland formation

7. 14
Hepatic Tumors, Malignant 7
Comment
At times the presence of what appears to be glands in the tumor raises the possibility of a cholangiocarcinoma versus a metastatic adenocarcinoma.
The cells making up the “pseudoglands” in hepatocellular carcinoma stain with specific liver cell immunohistochemical markers (Hep Par 1, arginase) and are infrequently positive and usually negative in markers for ducts (CK7, CK19, CA19-9).
In addition, bile within the lumen is diagnostic of a hepatocellular (not ductular) primary.
This case example also shows the variation in morphology that oftentimes occurs in the same tumor.