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Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report

INTRODUCTION: A primary acinar cell carcinoma (ACC) of the liver was incidentally diagnosed in a clinically asymptomatic 80-year-old man. This study aimed to delineate critical diagnostic characteristics of an ACC originating uniquely from the liver to improve its future identification. PRESENTATION...

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Autores principales: Grab, J.G., Skubleny, D., Kneteman, N.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734173/
https://www.ncbi.nlm.nih.gov/pubmed/31499412
http://dx.doi.org/10.1016/j.ijscr.2019.08.006
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author Grab, J.G.
Skubleny, D.
Kneteman, N.M.
author_facet Grab, J.G.
Skubleny, D.
Kneteman, N.M.
author_sort Grab, J.G.
collection PubMed
description INTRODUCTION: A primary acinar cell carcinoma (ACC) of the liver was incidentally diagnosed in a clinically asymptomatic 80-year-old man. This study aimed to delineate critical diagnostic characteristics of an ACC originating uniquely from the liver to improve its future identification. PRESENTATION OF CASE: Enhanced MRI revealed a heterogenous, cystic 7.7 × 11.1 × 10.4 cm tumour occupying hepatic segments II and III. The mass demonstrated mild diffuse enhancement in hepatic arterial phase with minimal portal venous washout in a liver without cirrhotic features. A central stellate T2-hyperintense necrotic scar and outer capsule were apparent. No primary lesion or metastasis outside the liver was discernable. Post-left hepatic lobectomy, the tumour immunophenotype was atypical for presumptive diagnoses of hepatocellular carcinoma (HCC) or cholangiocarcinoma. Extensive morphologic workup on electron microscopy definitively diagnosed primary hepatic ACC by establishing presence of secretory zymogen-like granules, intracytoplasmic microvilli and acinar cell differentiation. Cytopathology revealed cellular lumen expressing PAS-positive diastase-resistant granular cytoplasmic contents. DISCUSSION: This case showcased the novel utility of electron microscopy that was crucial in yielding the definitive diagnosis. The previous literature on hepatic ACC was compiled here in context of the present case. The mechanism of hepatic acinar cell localization was also discussed. CONCLUSION: Primary hepatic ACC may easily be confused for other lesions due to nonspecific imaging patterns. Specifically, the presence of a central scar without risk factors for HCC can favour a diagnosis of benign entities such as focal nodular hyperplasia (FNH). Electron microscopy presents an important tool to identify primary hepatic ACC and may improve future patient outcomes.
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spelling pubmed-67341732019-09-12 Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report Grab, J.G. Skubleny, D. Kneteman, N.M. Int J Surg Case Rep Article INTRODUCTION: A primary acinar cell carcinoma (ACC) of the liver was incidentally diagnosed in a clinically asymptomatic 80-year-old man. This study aimed to delineate critical diagnostic characteristics of an ACC originating uniquely from the liver to improve its future identification. PRESENTATION OF CASE: Enhanced MRI revealed a heterogenous, cystic 7.7 × 11.1 × 10.4 cm tumour occupying hepatic segments II and III. The mass demonstrated mild diffuse enhancement in hepatic arterial phase with minimal portal venous washout in a liver without cirrhotic features. A central stellate T2-hyperintense necrotic scar and outer capsule were apparent. No primary lesion or metastasis outside the liver was discernable. Post-left hepatic lobectomy, the tumour immunophenotype was atypical for presumptive diagnoses of hepatocellular carcinoma (HCC) or cholangiocarcinoma. Extensive morphologic workup on electron microscopy definitively diagnosed primary hepatic ACC by establishing presence of secretory zymogen-like granules, intracytoplasmic microvilli and acinar cell differentiation. Cytopathology revealed cellular lumen expressing PAS-positive diastase-resistant granular cytoplasmic contents. DISCUSSION: This case showcased the novel utility of electron microscopy that was crucial in yielding the definitive diagnosis. The previous literature on hepatic ACC was compiled here in context of the present case. The mechanism of hepatic acinar cell localization was also discussed. CONCLUSION: Primary hepatic ACC may easily be confused for other lesions due to nonspecific imaging patterns. Specifically, the presence of a central scar without risk factors for HCC can favour a diagnosis of benign entities such as focal nodular hyperplasia (FNH). Electron microscopy presents an important tool to identify primary hepatic ACC and may improve future patient outcomes. Elsevier 2019-08-17 /pmc/articles/PMC6734173/ /pubmed/31499412 http://dx.doi.org/10.1016/j.ijscr.2019.08.006 Text en © 2019 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Grab, J.G.
Skubleny, D.
Kneteman, N.M.
Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report
title Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report
title_full Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report
title_fullStr Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report
title_full_unstemmed Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report
title_short Cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: Case report
title_sort cytopathology and ultrastructure identification of primary hepatic acinar cell carcinoma: case report
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734173/
https://www.ncbi.nlm.nih.gov/pubmed/31499412
http://dx.doi.org/10.1016/j.ijscr.2019.08.006
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