Fine needle biopsy of malignant tumors of the liver: a retrospective study of 624 cases from a single institution experience

Our plain-English summary of Fine needle biopsy of malignant tumors of the liver: a retrospective study of 624 cases from a single institution experience, by L. Zhang, Z. Cai, J. Rodriguez, et al (Diagnostic Pathology, 2020).

The study

• Authors: L. Zhang, Z. Cai, J. Rodriguez, S. Zhang, J. Thomas, H. Zhu
• Journal: Diagnostic Pathology
• Published: 2020;15(1):43
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Liver is one of the most common organs involved by metastatic neoplasms. In addition, a number of primary tumors can arise in the liver. Fine needle biopsy (FNB) is the most commonly used method for diagnosis of liver masses. Not much literature is available during the past 10 years about FNB of liver tumors. All large studies were performed more than 15 years ago. With the introduction of new disease entities, new tumor classification systems, and new diagnostic methods, updated documentation of FNB of liver neoplasms is much needed.

Methods: Liver FNB cases that were diagnosed as "Positive for Malignancy" between 2010 and 2018 were retrieved from the cytopathology database in our institution. Patient medical records, cytopathology and surgical pathology reports, and slides from selected cases were retrieved and reviewed.

Results: Over 30 different types of malignant tumors were identified in 624 malignant FNB cases, with the most common tumors being metastatic colorectal and pancreatic adenocarcinomas. Rare tumors include EBV-positive leiomyosarcoma, mesothelioma, and paraganglioma, among others. A subset of patients presented with widespread metastases involving liver with no known history. Identifying the primary sites in those cases can be challenging. We also found that in our practice, a significant number of hepatocellular carcinoma were diagnosed by FNB in recent years.

Conclusions: A tremendous variety of neoplasms can occur in liver. Accurate diagnosis is essential for proper patient management. Familiarization with morphological features and judicious usage of ancillary studies are essential for accurate diagnosis.

In plain English

This retrospective study from the University of Texas Health Science Center at Houston reviewed 624 liver fine needle biopsies diagnosed as cancer between January 2010 and December 2018. The authors reviewed records and re-examined selected slides. The article does not mention asbestos. Its table of cancers of unknown origin lists smoking as pertinent history for three patients. Cancers that had spread from elsewhere made up 448 of 624 cases (71.8%), and cancers that began in the liver made up 176 (28.2%). Metastatic adenocarcinoma was the most common diagnosis (317 cases, 50.8%). Hepatocellular carcinoma was the most common cancer that began in the liver, at 97 of 176 (55.1%). Mesothelioma was found in 1 case (0.2%), which the authors listed among tumors rare in the liver. Table 1 does not mark it as a cancer that began in the liver, so it was counted among the metastases. The article does not give its original site or the patient's history. In 12 cases (1.9%) the cancer's origin could not be found. In one of these, the clinical impression was mesothelioma versus ovarian carcinoma, but the biopsy showed poorly differentiated adenocarcinoma. The authors concluded that a tremendous variety of tumors can occur in the liver.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of pathology cases from a single institution
• Who was studied: 624 liver fine needle biopsy cases diagnosed as malignant, January 2010 to December 2018, at the University of Texas Health Science Center at Houston
• Exposure: No exposure was studied, and asbestos is not mentioned. The article is about which types of cancer were diagnosed by liver biopsy. Its table of the 12 cancers of unknown origin lists smoking as pertinent history for three patients, one of them with smoking and COPD. Elsewhere it mentions some patients' medical conditions, such as hepatitis C virus-associated cirrhosis and HIV. It does not present full exposure histories.
• Main results:
  • Metastases were 448 of 624 cases (71.8%). Cancers that began in the liver were 176 of 624 (28.2%).
  • Metastatic adenocarcinoma was the most common diagnosis: 317 of 624 cases (50.8%).
  • Among the 176 cancers that began in the liver, hepatocellular carcinoma was the most common: 97 of 176 (55.1%).
  • Mesothelioma was found in 1 of the 624 cases (0.2%), and the authors listed it among tumors rare in the liver. Table 1 marks cancers that began in the liver with a superscript 'a'. The mesothelioma entry has no such mark, so it was counted among the metastases. Its original site and the patient's history are not given.
  • 12 of 624 cases (1.9%) were carcinoma of unknown primary, meaning the original site could not be found. Patients were aged 31 to 81, with 9 men and 3 women. The authors reported poor prognosis for these patients.
  • In one of the unknown-primary cases (case 6, a 56-year-old woman), the clinical impression was mesothelioma versus ovarian carcinoma. The pathologic finding was poorly differentiated adenocarcinoma.
• The authors' conclusion: The authors concluded that a tremendous variety of tumors can occur in the liver. They also concluded that familiarity with how these tumors look under the microscope, together with judicious use of additional tests, is essential for accurate diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Needle Biopsy, Neoplasm, Cytology, Pathology Report, Adenocarcinoma, Mesothelioma, Carcinoma.

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• Fine needle aspiration cytology of well-differentiated papillary mesothelioma: a case report — Y. Gong, R. Ren, et al. (2005)
• The role of endobronchial ultrasound-guided fine needle aspiration in the diagnosis of pleural mesothelioma — M.R. Ghigna, A. Crutu, et al. (2016)
• A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma — B.T. Welch, P.W. Eiken, et al. (2017)
• Pulmonary needle aspiration biopsy in the diagnosis of Pancoast tumors — W.J. Walls, J.R. Thornbury, et al. (1974)

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