Title: Cytomorphological Spectrum of Lesions in Liver at Tertiary Care Centre, Haryana
Authors: Dr Gajender Singh, Dr Padam Parmar, Dr Sant Prakash Kataria, Dr Nisha Marwah, Dr Sumiti Gupta, Dr Suman Tomer
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.60
Abstract
Introduction: Benign and malignant hepatic lesions need timely and accurate diagnosis for proper management. Fine needle aspiration cytology (FNAC) under ultrasonograhy guidance is primary investigation for liver lesion specially in deep seated lesions as it is minimally invasive, precise and reproducible investigation.
Material and methods: A total of 95 cases suspected for liver lesions were subjected to FNAC over a period of one year. Coagulation parameters along with complete blood counts were done on all the patients. The cytological aspirates were obtained using a 22 gauze spinal needle under ultrasound evaluation. Air dried and wet fixed (95% alcohol) smears were prepared for May-Grunwald Giemsa and Papanicolaou or Hematoxylin and Eosin stain respectively. Special stains were used wherever necessary. Diagnosis was made on the basis of cytomorphological features of the lesion.
Results: Patients age ranged from 15-90 years with maximum number of patients were in sixth decade. There was male predominance. The cytological diagnosis was made 79% cases. Cytomorphologically liver lesions were categorized in to malignant (58.95%), benign (11.58%), and non-conclusive (21.05%). Benign lesions included cirrhosis liver (5), fatty liver (4), and pyogenic liver abcess (2). Out of 56 malignant cases, 51 (91.07%) were of metastatic deposits including adenocarcinoma, renal cell carcinoma, mesenchymal tumor, mucinous and sqamous cell carcinoma. 5 cases (8.93%) were of primary origin which all are hepatocellular carcinoma (HCC). Primary site for liver metastasis was diagnosed in 33 cases (64.7%) and unknown in 18 cases (35.3%). Primary origin from various sites included from gall bladder (n=10), gastrointestinal tumor (n=6), pancreas (n=6), breast (n=5), bronchogenic (n=3), renal cell carcinoma (n=2) and mesenchymal (n=1).
Conclusion: Along with other supportive investigation finding, FNAC have important role in the diagnosis and management of various hepatic lesion in early stage.
References
1. Kuo FY, Chen WJ, Lu SN, Wang JH, Eng HL. Fine needle aspiration cytodiagnosis of liver tumors. Acta Cytol. 2004;48:142–8.
2. Shah A, Jan GM. Fine needle aspiration cytology of liver. A study of 518 cases. J Cytol 2002;19:139-43.
3. B.Bastian. Liver and Spleen. In: Orell SR, Sterret GF, Whitaker D, editors. Fine needle aspiration cytology. 5th ed. New Delhi: Churchill Livingstone; 2005. pp. 271–296.
4. Sattar A, Khan AM, Anjum S, Naqvi A. Role of ultrasound guided fine needle aspiration cytology in diagnosis of space occupying lesions of liver. J Ayub Med Coll Abbottabad 2014;26:334-6.
5. Whitlach S, Nunez C, Pitlik DA. Fine needle aspiration of the liver. A study of 102 consecutive cases. Acta Cytol 1984;28:719-25.
6. Yousaf NW, Jafri S, Masood G, Malik SA. The diagnostic role of fine needle aspiration cytology of liver in malignant focal mass lesions: A cytological correlation. JCPSP 2000;10:109-12.
7. Roy M, Bhattacharya A, Gupta DS, Sanyal S. Fallacies of fine needle aspiration cytology of surgical lesions of liver. J Ind Med Assoc 1994;92:285-87.
8. Ali SR, Jayabackthan L, Rahim S, Sharel MB, Prasad K, Hegdekatte N. Role of fi ne needle aspiration cytology in the diagnosis of hepatic lesions. Muller J Med Sci Res 2015;6:125-8.
9. Gatphoh ED, Gaytri S, Babina S, Singh AM. Fine needle aspiration of liver: a study of 202 cases. Indian J Med Sci.2003;57:22–5.
10. Swami M, Arathi CA, Kodandaswamy CR. Value of Value of ultrasonography guided fine needle aspiration cytology in the investigative sequence of hepatic lesions with an emphasis on hepatocellular carcinoma.J Cytol. 2011;28:178-84.
11. Rasania A, Pandey CL, Joshi N. Evaluation of FNAC in diagnosis of hepatic lesion. J Cytol. 2007;24:51–4.