Metastatic hepatocellular carcinoma (hCC) in adrenal fine-needle aspirate Cytopathologic findings in an unusual case
✍ Scribed by Stephanie R. Schreiner; Douglas P. Clark; Syed Z. Ali
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 406 KB
- Volume
- 21
- Category
- Article
- ISSN
- 8755-1039
No coin nor oath required. For personal study only.
✦ Synopsis
Findings in an Unusual Case
Dear Dr. Bedrossian:
Metastatic malignancy in the adrenal gland is more common than primary tumors of this organ; it is observed in 26% of all patients with metastatic disease. 1 The most common primary tumors that metastasize to the adrenals are carcinomas from the lung, breast, gastrointestinal tract, thyroid, and kidney. 2 Hepatocellular carcinoma (HCC) is an unusual cause of adrenal metastasis; it is found in only 15% of metastatic HCCs. 3 We recently encountered an unusual case of metastatic HCC, found incidentally in the adrenal gland of a 65-year-old man.
The mass was discovered on abdominal CT scan, done as part of the clinical follow-up after orthotopic liver transplantation for hepatitis B-associated cirrhosis, performed 2.5 yr earlier (Fig. 1). Histopathologic examination of the explanted liver at that time showed two incidental, small foci of well-differentiated HCC. The patient had done well in the 2.5-yr period after transplantation, until the adrenal mass was discovered.
Fine-needle aspiration (FNA) of the left adrenal gland was accomplished under ultrasound guidance, using a 22-gauge Franseen needle. Smears were both air-dried for Diff-Quik staining and wet-fixed in 95% ethanol for subsequent Papanicolaou staining. Immunoperoxidase (IPOX) staining was carried out on the cell-block sections, employing conventional methodology and using polyclonal carcinoembryonic antigen (CEA), cytokeratins (AE 1 /AE 3 ), alpha 1antitrypsin (AAT), and hepatitis B surface antigen (HBsAg). A periodic acid-Schiff (PAS) stain with and without diastase digestion was also performed.
Smears were hypercellular and showed numerous single cells, clusters, and tissue fragments of the tumor (Fig. C-1).