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Poorly differentiated hepatocellular carcinoma (G4 according to Edmondson and Steiner).
Haematoxylin & Eosin (H&E)
70 years
70-year male patient with a liver mass.
Liver biopsy showing infiltrates of a poorly differentiated malignant tumor. Tumor cells resemble hepatocytes but are highly atypical with prominent nuclear pleomorphism. Of note there are prominent intra- and peritumoral inflammatory infiltrates.
Residual liver parenchyma (not shown) exhibits florid steatohepatitis (ASH/NASH) with formation of septae; complete cirrhosis ist not present (yet).
Ancillary studies are not needed in this case. However, if hepatocellular derivation is not clearly evident in a malignant tumor, one can perform additional immunohistochemical stains (e.g. hepar1 or arginine). At times, differentiating high-grade dysplastic nodules from well differentiated hepatocellular carcinoma can be extremely challenging. In these cases applying an immunohistochemical panel consisting of HSP70, glypican3 and glutamine synthetase can be useful since positivity for 2 of these 3 antibodies is in favor for a hepatocellular carcinoma.
Philippe Brunner, University of Basel
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