Clinico-cytopathological spectrum of hepatocellular carcinoma, its correlation with serum alpha-fetoprotein level, and hepatitis B and C viral markers.

Fine-needle aspirationbiopsy (FNAB) is now widely accepted as a diagnostic modality for the treatment of hepatocellular carcinoma (HCC). The most common diagnostic problem in HCC is distinguishing it from a metastatic carcinoma. The literature from India on HCC is scanty. Hence, we studied the cytomorphological features of HCC and metastatic carcinoma. The study included 37 cases of space-occupying lesions (SOLs) of the liver as demonstrated by ultrasound or computed tomography (CT) scan. Cytomorphological features of these SOLs were analyzed in all subsequent to FNAB. Hepatitis B surface antigen (HBsAg), anti-hepatitis C virus antibody (anti-HCV) and alpha-fetoprotein (AFP) were determined in all the cases by enzyme-linked immunosorbent assay (ELISA). The cytopathological diagnosis was HCC in 22 and metastatic carcinoma of the liver in 15. The individual cytomorphological features and which helped to make a definite diagnosis of HCC were: a high nuclear cytoplasmic ratio (81.8%), predominantly trabecular pattern (63.6%) and atypical naked nuclei (100%). Other features were prominent multiple nucleoli (63.3%), hyperchromasia (100%) and moderate anisonucleosis (59%). AFP was elevated in 81.8% of the cases with a mean of 634.8+812.7 ng/ml. HBsAg by ELISA was found to be positive in 72.7% of cases while only 1 case (4.5%) was positive for anti-HCV. In 1 case (4.5%), there was dual infection due to hepatitis B virus (HBV) and HCV. No viral cause was found in 18.3% of cases.

Brush cytology in malignant biliary obstruction.

Tissue diagnosis is essential for the management of patients with malignant biliary obstruction. We prospectively studied brush cytology in 30 patients with malignant biliary obstruction. Wire guided brush cytology was obtained from the stricturous segment during endoscopic retrograde cholangio-pancreatography. The study comprised of 30 patients (16 males, 14 females), with a mean age of 55 years (range 30-75 years). The obstruction was caused by carcinoma gallbladder in 16 cases, carcinoma head of the pancreas in 10 cases, and cholangiocarcinoma in 4 cases. Brush cytology was positive for malignancy in 8 cases (26.7%). Another 3 samples (10.3%), 1 from each group of tumors, were suspicious for malignancy. Cytology was positive in 25% of gallbladder cancers, 50% of pancreatic cancers, and 50% of cholangiocarcinomas. Brush cytology was positive in 6 of 18 (33.3%) proximal and 5 of 12 (41.7%) distal strictures. Brush cytology yielded a sensitivity of 36.7% in the diagnosis of malignant biliary strictures. However, a larger study is required to confirm these findings.