Source: DGNews  |  Posted 2 years ago

By John Otrompke

CHICAGO -- November 10, 2009 -- Because it can be very difficult to distinguish
liver metastases of adenocarcinoma from cancer cells which are native to the
liver under a microscope, pathologists should use 4 immunocytochemical panels,
including a newly researched protein called glypican, in combination with
cytomorphology to make the crucial distinction, according to a study presented
here at the American Society for Clinical Pathology (ASCP) 2009 Annual Meeting.

“When they are poorly-differentiated, these 2 types of cancer cells become
difficult to distinguish, but clinically it is very important to tell if the
patient has liver cancer or metastatic cancer from the lung or breast, because
the 2 diseases require a totally different treatment and management approach,”
said Husain Saleh, MD, Department of Pathology, Wayne State University School
of Medicine, and Sinai Grace Hospital, Detroit, Michigan, on November 3.

For the trial, researchers performed 7 immunocytochemical stains on 42 cases of
liver cancer and 48 cases of metastatic adenocarcinoma. Of the liver cancer
cases, 38 of 42 tumours were correctly identified by a panel of 4 markers with
an accuracy rate of 90.5%. The same panel correctly identified 44 of 48 of the
metastatic cancer cells, with an accuracy rate of 91.7%.

The 4 tests were for HepPar 1, an antigen present in the embryo; MOC 31, a
compound present on the surface of the cell, which reacts only with epithelial
cancer, not other forms of cancers; CK7, which functions like a skeleton of a
cell; and glypican, a marker the utility of which was only discovered within
the past year and a half, according to Dr. Saleh.

The panel of 4 tests should be used in conjunction with traditional
cytomorphology to distinguish the cells. While the use of standard observation
is tricky, there are clues that a trained pathologist can look for, said Dr.
Saleh.

“There are clues and hints to suggest one or the other,” he said. “For example,
in hepatocellular carcinoma, which starts in the liver, the cells have
prominent pleomorphism, such as the variable size and shape of the nucleus.
Another thing they have is macronucleoli, within the nucleus, because these in
the liver can be really big.” Other features of liver cancer include
intranuclear inclusions and naked nuclei, Dr. Saleh added.

“On the other hand, adenocarcinoma can have some unique features including
vacuolated columnar cytoplasm, cytoplasmic inclusions, and eccentric nuclei,”
he explained.

Presentation title: Discriminating Hepatocellular Carcinoma From
Metastatic Adenocarcinoma on Fine-Needle Aspiration Biopsy of the Liver: The
Utility of Immunocytochemical Panels. Abstract 47