Cytologic Evaluation of Primary Malignant Vascular Tumors of the Liver

Abstract

OBJECTIVE: To describe and compare the cytologic features of angiosarcoma (AS) and epithelioid hemangioendothelioma (EH) of the liver.

STUDY DESIGN: Fine needle aspirates and succeeding tissue biopsies from one case each of hepatic AS and EH were obtained. Both aspirates were compared for differences in cytologic features.

RESULTS: In the case of EH, the tumor cells were dispersed almost singly but occasionally assumed an acinuslike shape. They were polymorphic and had a folded nuclear outline with lacy and hematoxyphilic cytoplasm. Occasional intranuclear cytoplasmic inclusions and frequent binucleated or multinucleated giant cells were also characteristic. The tumor cells of AS showed tightly cohesive clusters forming syncytium in the bloody background with heavy aggregates of polymorphonuclear cells. The tumor cells were larger and more atypical but less polymorphic than those of EH. Each tumor cell of AS had a very distinct, huge, eosinophilic nucleolus and abundant cytoplasm of honeycombing micro/macrovesicular features. Frequently, huge intracytoplasmic vacuoles similar to those in signet-ring cells were present.

CONCLUSION: Preoperative diagnosis of malignant hepatic vascular tumor is possible by aspiration cytology provided that one is aware of these entities and some distinctive cytologic findings.