Role of FNA and Core Biopsy of Primary and Metastatic Liver Disease
Figure 3
. History: 72 year-old-male with cirrhosis due to alcoholism with AFP of five. Patient had surgical wedge resection with findings consistent with HCC. (a) Initial arterial CT phase shows encapsulated mass with minimal enhancement (arrow). (b) Portal phase shows well-demarcated area of decrease density with peripheral rim (arrow). (c) Delay imaging demonstrating some washout in this lesion (arrow). This was judged as equivocal for HCC on review. At this time, five FNA’s and one core sample which were thought to be nondiagnostic of HCC and were thought to be regenerating nodule versus HCC. (d) MRI with Eovist with 30 minutes delay scan demonstrating area with decrease signal intensity (arrow). (e) An addition a satellite lesion (arrow) was identified cephalad to primary lesion. Three cores were performed on the larger mass which were nondiagnostic and showed no malignancy. (f) Two year follow-up CT demonstrating mass which was locally invasive with multiple satellite lesions throughout the liver (arrows). (g) Other five FNA passes and five cores were obtained at that time which were considered to be satisfactory but nondiagnostic for malignancy. Less than 10% of the histology sample contained hepatocytes for evaluation. Some were disposed in nodules with altered reticulin (not shown). The cells have moderate N : C ratios and are not particularly atypical. Surgical wedge resection was performed which revealed HCC.
