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Cirrhosis, whether caused by alcoholic hepatitis, viral hepatitis or other diseases, results in a disruption of the normal liver architecture, with bands of fibrosis separating nodules of regenerating hepatocytes. Some nodules can be larger and raise the suspicious of a malignancy, such as hepatocellular carcinoma. As a matter of fact, patients with cirrhosis are at increased risk for developing hepatocellular carcinoma. Patients with a focal lesion in the setting of cirrhosis are often biopsied with FNA, although accuracy may be higher with needle biopsy.
Cytologic diagnostic features
- Normal-appearing hepatocytes, sometimes with steatosis
- Focal atypia in some cases (marked variation in nuclear size, prominent nucleoli, binucleation)
- Hepatocellular carcinoma
- Hepatic adenoma
- Focal nodular hyperplasia
- Normal liver
- Nodular regenerative hyperplasia (nodular transformation of the liver)
When hepatocyte atypia is due to cirrhosis, smears show a spectrum ranging from normal to markedly atypical hepatocytes, whereas smears from a hepatocellular carcinoma are usually monomorphic. In hepatocellular carcinoma, other diagnostic features are an increased N/C ratio, a trabecular arrangement of hepatocytes surrounded by endothelial cells, and atypical naked nuclei. The different benign conditions are cytologically indistinguishable and the diagnosis rests on clinical-pathologic correlation.