Cytologic findings and differential diagnosis in hepatic Epithelioid hemangioendothelioma: a case report
Epithelioid hemangioendothelioma is a rare tumor of vascular origin with nonspecific clinical and radiologic presentation. Cytologic findings described in the few case reports are variable. We describe a rare case of unifocal, hepatic hemangioendothelioma in a 47-year-old woman; a broad differential diagnosis of malignant neoplasm was considered during on-site evaluation of fine needle aspiration (FNA); diagnosis was made on subsequent core biopsy. To better describe the cytologic findings, FNA was performed on the resected tumor. The cytologic feature of this tumor, comparison with histol ogy findings and the differential diag nosis are discussed in detail. A correct diagnosis of hepatic epithelioid hemangioendothelioma can be rendered in cytology when an adequate specimen is obtained. The smears are characterized by a discohesive population of atypical cells in a clean background, fragments of metachromatic stroma, scattered benign hepatocytes and bile duct epithelium. The atypical cells are polygonal with abundant, dense cytoplasm and occasional tailing. On careful review, a few cells with a sharp, punched out intracytoplasmic lumen can be seen. The nuclei are round to reniform, with fine chromatin and occasionally prominent nucleoli. Sharply defined intranuclear cytoplasmic inclusions are seen in many cells, better appreciated in Papanicolaou-stained smears.