Peritumoral Hyperplasia of the Liver with Expression of Glutamine Synthetase – A Report of 6 Cases Adjacent to Metastatic Endocrine or Colon Carcinoma, Hepatocellular Carcinoma, or Hepatocellular Adenoma
IR Wanless, KE Fleming, TA Arnason. Dalhousie University, Halifax, NS, Canada
Background: Peritumoral hyperplasia (PTH) has been described in liver adjacent to FL-HCC as a single case report (Wanless 2000).
Design: Since this initial report we have discovered 2 cases associated with metastatic endocrine carcinoma (EC) and single cases associated with HCC, hepatocellular adenoma (HCA), or metastatic colon carcinoma (CC). This prompted a review of 8 metastatic EC yielding an additional case of PTH. Thus we report here 6 cases of PTH present adjacent to metastatic endocrine carcinoma (3), CC (1), ordinary HCC (1), and HCA (1). These cases were stained with H&E and trichrome. Immunohistochemical stains for CD34 and glutamine synthetase were performed.
Results: The PTH width varied from minimal to 5 mm. In all cases, the central tumor deposit was hypervascular with prominent CD34 positive capillaries or sinusoids. There was evidence of hepatic vascular invasion in all cases with metastatic disease. The PTH was strongly positive for hepatocellular GS in 5/5 lesions tested with a diffuse pattern including periportal hepatocytes. CD34 was strongly expressed in PTH sinusoidal endothelial cells in 3/5 tested.
Conclusions: PTH may be seen adjacent to many types of vascular neoplasms, especially endocrine carcinoma. GS is normally found in a narrow rim of perivenous hepatocytes. However, in PTH GS is strongly expressed in perivenular and periportal hepatocytes. Recently, GS expression has been reported to be increased in perivenous hepatocytes of FNH with a map-like pattern (Bioulac-Sage 2009). Because FNH is widely believed to be a response to increased arterial blood flow, our observation indicates that PTH and FNH may be physiologically related with increased blood flow as a common factor. In addition, our observation may help to illuminate the control mechanisms of GS expression.
Category: Liver & Pancreas
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 232, Tuesday Morning