Elsevier Pathology

Anatomic Pathology: Liver Pathology

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239) The slide presented in the image shows an immunostain of a CT-guided liver biopsy specimen from a 5-cm tumor in a 56-year-old man with chronic hepatitis C and cirrhosis. Serum α-fetoprotein was markedly elevated, and HCC was suspected. Which of the following immunostain methods was used?

• When a liver specimen demonstrates a malignant neoplasm, the classic set of immunostains to be ordered first to distinguish between metastatic carcinoma versus primary HCC includes cytokeratin 7 + cytokeratin 20 + HepPar1 + polyclonal CEA (or, alternatively, CD10 in place of polyclonal CEA).

• If the HCC is only moderately differentiated or poorly differentiated, HepPar1 immunostaining may be negative, and in that case an alternative trio including glypican-3, glutamine synthetase, and heat shock protein 70 should be ordered.

• Arginase-1 is an additional immunohistochemical marker of hepatocytes and hepatocellular neoplasms.

Kakar S, Gown AM, Goodman ZD, et al: Best practices in diagnostic immunohistochemistry: hepatocellular carcinoma versus metastatic neoplasms. Arch Pathol Lab Med 2007;131(11):1648-1654.

Shifizadeh N, Ferrell LD, Kakar S: Utility and limitations of glypican-3 expression for the diagnosis of hepatocellular carcinoma at both ends of the differentiation spectrum. Mod Pathol 2008;21(8):1011-1018.

Yan BC, Gong C, Song J, et al: Arginase-1. A new immunohistochemical marker of hepatocytes and hepatocellular neoplasms. Am J Surg Pathol 2010;34(8):1147-1154.

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