1. Chapter 14
Hepatic Tumors, Malignant 1
In situ hepatocellular carcinoma arising in a macroregenerative cirrhotic nodule (chronic HCV infection)
Case #14.29

2. Clinical Presentation14
Hepatic Tumors, Malignant 2
Clinical Presentation
A 59-year-old woman with well-established cirrhosis secondary to chronic hepatitis C was found to have a well-delineated sub-capsular nodule measuring 2.5 × 1.8 cm.
A wedge resection was performed.

3. 14
Hepatic Tumors, Malignant 3
Pathology
A well-established cirrhosis was present with occasional macroregenerative nodules but no obvious tumor.
Microscopy showed some of the larger regenerative nodules to have focal areas of cytologic atypia of the hepatocytes, the cells having hyperchromatic nuclei and scanty clear to basophilic cytoplasm (arrows) (a, b).
14.29(a)
14.29(b)

4. 14
Hepatic Tumors, Malignant 4
Pathology
The reticulin stain showed the atypical hepatocytes forming thickened cords (arrows) (c).
14.29(c)

5. Pathology 14 Hepatic Tumors, Malignant 5
Immunoperoxidase stains showed the following: glypican-3, strong staining of the atypical cells (upper left), negative staining of the regenerative hepatocytes (d); pCEA, canalicular, cell membrane and cytoplasmic staining of the atypical cells (e).
14.29(d)
14.29 (e)

6. 14
Hepatic Tumors, Malignant 6
Diagnosis
In situ hepatocellular carcinoma arising in a macroregenerative cirrhotic nodule (chronic HCV infection)

7. 14
Hepatic Tumors, Malignant 7
Comment
Dysplastic regenerative cirrhotic nodules are the precursors of hepatocellular carcinoma, especially cirrhosis due to chronic HBV and HCV.
Although glypican-3 can show focal staining of hepatocytes in dysplastic regenerative nodules, the diffuse strong staining in the dysplastic areas of the nodules in this case example is supportive of hepatocellular carcinoma.
pCEA can show canalicular staining in both benign and malignant hepatocellular tumors; however, the focal cytoplasmic staining is only seen in the malignant variants.
Furthermore, the reticulin stain showing thickened hepatic cords is diagnostic in this case example for hepatocellular carcinoma.