Useful histopathologic features for diagnosing focal liver lesions with spindle cell morphology: A clinicopathologic study |
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| Institution: | 1. Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand;2. Division of Pathology, Thammasat University Hospital, Pathumthani, Thailand;3. Department of Pathology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand;1. Department of Pathology & Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA;2. University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35233, USA;3. Penn State Health Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA 17033, USA;1. Department of Pathology, University of California San Diego, La Jolla, CA, United States of America;2. Health Sciences International, University of California San Diego, La Jolla, CA, United States of America;1. Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China;2. Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China;3. Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100069, China;4. Department of Pathology and Key Laboratory for Xinjiang Endemic & Ethnic Diseases, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, 832002, China;5. Department of Pathology, Shanghai PuDong GongLi Hospital, Shanghai, 200135, China;1. N.N. Petrov Institute of Oncology, St.-Petersburg 197758, Russia;2. Moscow City Oncological Hospital №62, Moscow 143423, Russia;3. S. Berezin International Institute of Biological Systems, Saint-Petersburg 197758, Russia;4. St.-Petersburg Pediatric Medical University, St.-Petersburg 194100, Russia;5. I.I. Mechnikov North-Western Medical University, St.-Petersburg 191015, Russia;1. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States of America;2. Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America;3. Department of Medicine, University of Washington, Seattle, WA, United States of America |
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| Abstract: | BackgroundFocal liver lesions with spindle cell morphology are rare in the daily practice of pathology. The differential diagnosis is broad, including both tumors and tumor-like lesions. Initial radiologic assessment is sometimes inaccurate. Histopathology is needed to arrive at the correct diagnosis. This study analyzed discrepancies between histopathology and radiologic findings of focal liver lesions with spindle cell morphology.MethodsA six-year retrospective analysis was conducted at a tertiary hospital in Thailand. All focal liver lesions with spindle cell morphology were retrieved. Clinicopathologic features of these cases were analyzed. The pathological diagnosis was rendered primarily based on routine histopathology, using other ancillary studies as an adjunct.Results287 biopsies and 151 resection specimens with focal liver lesions were identified. In 12 (2.7%) cases, tumors or tumor-like lesions with spindle cell morphology were retrieved. A total of five cases had discrepancies between histopathology and radiologic findings. These lesions encompassed primary liver tumors (EBV-associated smooth muscle tumor and leiomyosarcoma); metastatic tumors (gastrointestinal stromal tumor, small cell neuroendocrine carcinoma); and a tumor-like lesion (endometriosis). Several morphologic findings (i.e., cytologic grades, dense and loose areas, intratumoral lymphocytes, distinct perinuclear vacuoles, and hemosiderin) are important clues to diagnose these spindle cell lesions.ConclusionsPathologists play a critical role in diagnosing focal liver lesions with spindle cell morphology, particularly those with limited clinical data at the initial presentation. A thorough evaluation of histomorphology on routine hematoxylin and eosin-stained slides is essential for correct diagnosis. |
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