European Journal of Biomedical and Pharmaceutical Sciences

CYTOMORPHOLOGICAL CLASSIFICATION OF SPACE OCCUPYING LESIONS OF LIVER AT A TERTIARY CARE CENTER

Sayeed MU, Sarwar M*, Kumuda C and Ahalya SM

ABSTRACT

Single or multiple lesions in liver which are diagnosed by clinicians with patient’s history and clinical examination and by radiologist with ultrasonography or Computed tomography scan constitute the main indication for Fine needle aspiration cytology (FNAC) of liver. Since it’s an invasive procedure, it’s a big challenge even to an experienced cytopathologist. Mainly the problem occurs when a well differentiated hepatocellular carcinoma is mistaken for benign tumor or a poorly differentiated hepatocellular carcinoma is mistaken for a metastatic lesion. Most of these problems could be resolved with the aid of new techniques like immunohistochemistry,molecular studies etc. The problem still persists when these facilities are unavailable.The present study was undertaken to classify the Space Occupying Lesions (SOL) of liver cytomorphologically with emphasis on hepatocellular carcinoma. Fine needle aspiration cytology samples were collected for the duration of one year at a tertiary care center. Each case is evaluated according to history, chief complaints and clinical diagnosis. Inclusion criteria for our study are patients with history of liver disease, who had clinically and radiologically diagnosed liver disease, both males and females and any age group. Exclusion criteria- those who are clinically diagnosed but radiologically don’t have any space occupying lesion in liver. With all aseptic precautions and under the guidance of ultrasound, FNAC was done after taking consent. Total numbers of cytology samples were 3180 which included hepatic and non-hepatic lesions.The numbers of liver Space occupying lesions (SOL) samples were 52 that accounts to 1.64 % of the total number of liver samples. Male to female ratio was 5.5:1(43 males, 9 females) and age ranges from 16 months to 86 years. The samples were divided into non-neoplastic (9.62%), neoplastic (76.92%) and inadequate for opinion (13.46%). Acute inflammation (Abscess)(1.9%), chronic nonspecific inflammation(3.8%), and regenerating nodules(3.8%) were the non-neoplastic lesions encountered. Neoplastic lesions were more common than non-neoplastic lesions.Neoplastic conditions were classified into primary and secondary. Primary neoplasms were further classified into benign and malignant. The most common primary malignant tumor was hepatocellular carcinoma (53.8%). Second most common SOL of liver is secondaries (19.2%). Other malignant tumor seen was hepatoblastoma (3.8%). Secondaries were deposits of colorectal adenocarcinoma.The sensitivity, specificity and diagnostic accuracy of FNAC in our study was 86.5%, 94.3% and 100% respectively. FNAC is an excellent procedure to diagnose Space Occupying lesions of liver. It can be taken from both right and left lobes and from superficial or deep lesions.

Keywords: Fine needle aspiration cytology, Space Occupying Lesions of liver, abscess, regenerating nodule, Hepatocellular carcinoma and secondaries.