Metastatic HCC. Key findings are the presence of many naked nuclei, as demonstrated here, as well as trabecular growth with disordered balls of cells. Other suggestive features to look for include branching fine capillary proliferation, endothelial cell wrapping around "packeting", macronucleoli, and evidence of bile production by malignant-appearing cells.
Low grade MEC. The key diagnostic features on FNA are the presence of several cell types, including glandular, squamous, and intermediate cells. In low grade lesions, mitoses are rare and necrosis is absent.
HCC. show numerous large, cohesive fragments at low power. These fragments have an arborizing, branching architecture. At high power, these cells have round nuclei, occasional prominent nucleoli, and bile pigment. Endothelial cells are seen "wrapping" around atypical hepatocytes in the Papanicolaou stained material and in the core biopsy.
Acinic cell CA. The aspirate is very cellular and shows numerous large tissue fragments. Large vessels run through the center of several fragments. Scattered naked nuclei are present in a background of granular material, but no significant lymphocytic infiltrate is identified, nor is there normal ductal epithelium or adipose tissue. The uniform cells are arranged in groups of small acini with nuclear polarization. The cells show abundant granular cytoplasm with occasional foamy vacuolization…
Mesothelioma. The presence of intercellular windows and cytoplasmic skirts are two important diagnostic clues in this case. Both features support mesothelial origin and both are the result of long floppy microvilli that characterize mesothelial cells. Other less specific cytologic features that support mesothelial origin include: Single cell population scalloped borders of fragments papillary architechture cell-in-cell arrangements multinucleation
Hepatoblastoma. Three cell types. undifferentiated (small cells reminiscent of neuroblastoma or Wilms tumor), embryonal cells (slightly more mature cells with large nuclei, scant cytoplasm, arranged in some architectural pattern), and fetal cells (larger cells with abundant cytoplasm, smaller than mature hepatocytes).
Osteosarcoma. Had pleomorphic giant cells. The presence of spindle cells with delicate cytoplasm radiating from the nucleus suggests a sarcomatous process. This finding, in addition to the identification of pleomorphic and atypical giant cells, in the context of plasmacytoid polygonal cells, suggests osteosarcoma.