Vacuolated Cell Pattern as a Diagnostic Feature of Pancreatobiliary Origin for Carcinomas Identified in Liver Biopsies.
Tarek Jazaerly, Sudeshna Bandyopadhyay, Olca Basturk, Nevra Dursun, Bassam Albashiti, Nil Culhaci, Volkan Adsay. WSU/DMC/KCI, Detroit, MI; MSKCC, New York; Emory Univ, Atlanta, GA; WSU/DMC, Detroit, MI; Adnan Menderes Univ, Aydin, Turkey
Background: Liver is the most common site for metastatic carcinoma. The primary origin and corresponding treatment are commonly based solely on histopathologic evaluation of small, challenging biopsies. Most pancreatobiliary adenocarcinomas (PBA) present with liver metastasis, and PBA is one of the most common and misdiagnosed sources of carcinomas of unknown primary. We recently described a distinctive vacuolated cell pattern (VCP) of PBA (Virchows Arch, in press, 2011).
Design: 209 liver biopsies with metastatic carcinoma were retrieved from our database and reviewed to identify VCP, which is characterized by multicell-size vacuoles with signet-ring appearance occurring in clusters of cells, imparting them a cribriform pattern. The vacuoles often merge to form multilocular spaces separated by a thin rim of cell membrane. The nuclei are hyperchromatic, with significant atypia and are often pushed to the periphery resembling adipocytes (lipoid cell pattern). Many of the vacuoles contain granular secretory material, some with targetoid appearance, admixed with cellular debris, neutrophils and mucin. True lumen formation lined by epithelial cells was not considered as VCP.
This was confirmed by 2 pathologists after a blinded slide review. The primary site was established by clinical findings.
Results: VCP was identified in 46 of 82 cases of PBA (56%). Occasional vacuoles resembling those of VCP were identified 15 of 127 carcinomas of non-PBA origin (2/15 ovarian, 8/43 colonic, 3/11 upper G.I., 2/15 ovary, 0/5 lung, 0/38 others); however, only 2 of these (colon and upper G.I.primaries) had characteristic features of VCP. Sensitivity and specificity of VCP for PBA was 56% and 88% respectively.
Conclusions: Although not very common, the vacuolated cell pattern is a fairly helpful adjunct in the differential diagnosis of metastatic carcinomas involving the liver. If this pattern is encountered, the possibility of PBA ought to be considered as the most likely primary.
Category: Liver & Pancreas
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 214, Tuesday Afternoon