Focal nodular hyperplasia |
3rd to 5th decade, females |
Usually solitary Multicentricity in 20% case. Subcapsular, grayish-white, depressed scar present |
The cellular morphology and relationship between hepatocytes and bile ducts are similar to normal liver. Fibrous septa with thickened vessels divide the lesion into pseudo-lobules. Fibrovascular and ductular areas radiating from the septa. |
Arginase and HepPar1 - positive in hepatocytes. Glutamine synthetase- Map like positivity. Alpha1-Antitrypsin positive. Glypican 3, HMB45, MelanA and SMA- negative. |
Hepatic adenoma |
3rd to 5th decade, females |
Usually solitary. Capsulated, different color of lesion as compared to adjacent liver |
Well-differentiated hepatocytes with abundant eosinophilic granular cytoplasm. No portal triads or central veins. No connection with the biliary system. Kupffer cells present |
Arginase and HepPar1-Positive. Estrogen and Progesterone receptors (75% cases), Androgen receptors (20% cases). Glypican3, HMB45, MelanA and SMA- negative. |
Hepatocellular carcinoma |
Usually 5th decade, males |
Solitary, multinodular, diffuse, and massive forms. Background liver is usually cirrhotic. |
Trabecular, solid, or tubular growth. Network of sinusoidal vessels surrounds the tumor cells. Less well differentiated cases show pleomorphism, bizarre mitotic figures, and tumor giant cells. Nucleoli are prominent, and the cytoplasm is scanty and basophilic. Well differentiated forms resemble normal hepatocytes. |
AFP, HepPar1, pan-cytokeratin, EMA, Alpha1-antitrypsin, fibrinogen, IgG, transferrin receptor, ferritin, MOC-31, Glypican3, Arginase-Positive. HMB-45, MelanA and SMA -negative. |
Leiomyoma |
No age or sex predilection |
Solitary, well circumscribed, rubbery, and whorled |
interlacing fascicles of uniform, spindled cells with a moderate amount of eosinophilic, often vacuolated cytoplasm are evident. Nuclei are plump and elongated with blunt ends (“cigarlike”); mitoses are absent or very rare |
SMA, Muscle specific actin- Positive. Glypican3, Arginase, HepPar1, HMB45 and MelanA-Negative. |
Epithelioid hemangioendothelioma |
Adult, females |
Usually multicentric |
Neoplastic endothelial cells infiltrate sinusoids and veins, both as tuft-like intravascular proliferations and as fibro thrombotic occlusions. These cells are plump, with an acidophilic cytoplasm that is often vacuolated |
Endothelial markers such as podoplanin (D2-40), CD31, CD34- Positive. SMA- occasionally positive. |
Glypican3, Arginase, HepPar 1, HMB45, MelanA- Negative |
Clear cell myomelanocytic tumor |
Young (3rd decade), females |
Solitary, large masses, usually in the right lobe |
Fascicles and nests of spindle shaped tumor cells with having clear to lightly eosinophilic cytoplasm, vesicular chromatin and prominent micronucleoli. Epithelioid appearance of tumor cells which are closely related to dilated vascular channels |
HMB45, Melan A, SMA, H-Caldesmon-Positive. |
Glypican3, arginase and HepPar 1-Negative. |