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Luoquan Wang, Magalis Vuolo, Mark Suhrland, Kathie Schlesinger Department of Pathology

MOC-31 and Hep par 1 are the most useful for distinguishing metastatic adenocarcinoma from hepatocellular carcinoma in liver fine needle aspirates. Luoquan Wang, Magalis Vuolo, Mark Suhrland, Kathie Schlesinger Department of Pathology. Background.

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Luoquan Wang, Magalis Vuolo, Mark Suhrland, Kathie Schlesinger Department of Pathology

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  1. MOC-31 and Hep par 1 are the most useful for distinguishing metastatic adenocarcinoma from hepatocellular carcinoma in liver fine needle aspirates Luoquan Wang, Magalis Vuolo, Mark Suhrland, Kathie Schlesinger Department of Pathology

  2. Background • CT- or US-guided fine needle aspiration biopsy (FNAB) is being widely used in diagnosis of liver lesions. • Advantages of FNAB, compared to core needle biopsy, include less trauma to patients, fewer complications, and it is easier to perform.

  3. Diagnostic challenges in liver FNAB specimens • Malignant vs. benign • Malignancy: hepatocellular carcinoma (HCC) vs metastatic adenocarcinoma (MA). -Clinically important - clinical management differs.

  4. Key elements for a successful FNAB: • Adequate material - on site assessment of adequacy. • Pathologist experience. • Adjunct tools: immunostains, molecular markers, EM, etc.

  5. Challenges in diagnosis of HCC vs MA on FNAB specimens • Limited material for evaluation. • Lack of histological context. • Overlapping morphologic features of poorly differentiated HCC and MA.

  6. Immunostains • Numerous antibodies have been tried in helping the differential diagnosis of HCC vs MA. -AFP, subtypes of cytokeratins, Ber-EP4, CD 10, polyclonal CEA (pCEA), monoclonal CEA (mCEA), etc. • Although some of them were found to be useful, the specificity and/or sensitivity of most of these antibodies has been limited.

  7. Two new antibodies were developed recently: • MOC-31, a marker for adenocarcinoma, had shown from 80% to 100% sensitivity and specificity on surgical specimens. • Hep par 1, a marker for HCC, also showed high sensitivity and specificity. • However, the sensitivity and specificity of these two antibodies have not been thoroughly tested on FNAB material, which is fixed and processed differently.

  8. Purpose • Test the sensitivity and specificity of MOC-31 and hep par 1 on FNAB specimens in comparison with AFP, CD10, mCEA and pCEA. • Improve the diagnostic accuracy on liver FNAB cell blocks by using immunostain panel.

  9. Materials and Methods • Fifty one liver FNAB cases- 18 HCCs and 33 MAs. • Cell block material was initially fixed in 50% ethanol/2% carbowax solution, to which Histochoice fixative was subsequently added. • AFP, CD10, mCEA, pCEA, MOC-31 and Hep par 1 immunostaining was done with Dako Envision system. • Appropriate positive and negative controls were used.

  10. Results • AFP, Hep par 1 and mCEA presented as cytoplasmic staining. • MOC-31 presented predominantly as membraneous staining. • Only canalicular reactive pattern of antibodies CD 10 and pCEA was considered specific for HCC.

  11. Hep, HCC

  12. MOC-31, MA

  13. AFP, HCC

  14. pCEA, HCC

  15. mCEA, MA

  16. CD10, MA

  17. hepatocytes CD10, MA

  18. pCEA, MA

  19. Conclusions • Hep par 1, MOC-31, mCEA, CD10, pCEA, and AFP all are useful markers for differential diagnosis of HCC vs MA on FNAB cell blocks • We suggest using Hep par 1, MOC-31, and mCEA as first line immunomarkers for distinguishing HCC from MA in liver FNABs.

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