Match each focal hepatic lesion to its characteristic histopathologic and immunohistochemical findings typically seen on a needle core biopsy or surgical resection.
- Focal nodular hyperplasiaNodular architecture with a central fibrous scar containing thick-walled dystrophic vessels and bile ductular proliferation; demonstrates a geographic, 'map-like' pattern of glutamine synthetase expression.
- Beta-catenin-activated hepatocellular adenomaBenign proliferation of hepatocytes frequently showing cytologic atypia and pseudoglandular formation; immunohistochemistry demonstrates strong, diffuse nuclear staining for beta-catenin.
- Well-differentiated hepatocellular carcinomaProliferation of hepatocytes arranged in broadened trabeculae (greater than 3 cells thick) with a decreased reticulin framework; demonstrates diffuse CD34 staining outlining capillarized sinusoids.
- Fibrolamellar hepatocellular carcinomaLarge polygonal cells with abundant intensely eosinophilic granular cytoplasm and prominent nucleoli, interspersed with dense, parallel bands of collagen; often occurs in young patients without cirrhosis.
Answer
Focal nodular hyperplasia pairs with the 'map-like' glutamine synthetase staining and central scar; Beta-catenin-activated hepatocellular adenoma pairs with diffuse nuclear beta-catenin staining; Well-differentiated hepatocellular carcinoma pairs with broadened trabeculae and CD34-positive capillarized sinusoids; Fibrolamellar hepatocellular carcinoma pairs with large eosinophilic cells and dense lamellar collagen bands.
Accurate interpretation of liver biopsy findings is crucial for establishing the diagnosis of focal hepatic lesions, as management ranges from observation to major resection or transplant. Focal nodular hyperplasia is identified by a central scar and geographic glutamine synthetase staining. Beta-catenin-activated adenomas show diffuse nuclear beta-catenin and require resection due to malignancy risk. Hepatocellular carcinoma is characterized by thickened trabeculae, loss of reticulin, and sinusoidal capillarization (CD34+). Fibrolamellar hepatocellular carcinoma has distinctive large oncocytic cells with dense lamellar fibrosis.
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Key Concept
Histopathologic and immunohistochemical differentiation of focal hepatic lesions