Hepatocellular Carcinoma with Both Fibrolamellar and Classical Components: An Unusual Morphological Pattern

Figure 2

(a) (H and E stain, 200x) Mixed tumor composed of two different components, one with large, polygonal cells with eosinophilic cytoplasm, consistent with FLC (top left). Adjacent to it without transition (bottom right), the second component shows a neoplastic proliferation of hepatocytes with high N : C ratio and a trabecular pattern compatible with classical HCC. (b) (H and E stain, 200x) typical abundant lamellar connective tissue characterizing FLC. (c) (H and E stain, 400x) High power view of FLC component showing large neoplastic cells with abundant eosinophilic cytoplasm and pale bodies. (d) (H and E stain, 200x) Photograph of classical HCC showing nests of neoplastic hepatocytes with abnormal architecture showing thick liver plates and endothelial wraping. (e) (Masson’s trichrome stain, 200x) Lamellar connective tissue in the FLC component. (f) (H and E stain, 100x) Low power view of adjacent liver parenchyma withouth fibrosis and few foci of nonspecific lymphocytic parenchymal inflammation with retained architecture. (g) (CK7-200x) Immunohistochemistry for CK7 showing positivity in FLC and (h) (CK7-400X) in the HCC. (i) (CK19-400X) Negative in HCC.

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