J Pathol Transl Med.  2022 Jul;56(4):225-230. 10.4132/jptm.2022.04.07.

Hepatic carcinoma expressing inhibin: case report of a proposed novel entity and review of the literature

• Syrnioti A
• Athanasiou E
• Hytiroglou P

• KMID: 2531615
• DOI: http://doi.org/10.4132/jptm.2022.04.07

Abstract

Hepatic carcinoma expressing inhibin is a recently described neoplasm with varied architecture, including trabecular, pseudoglandular, follicular/microcystic, organoid, solid and tubular patterns of growth. We report a case of hepatic carcinoma expressing inhibin that occurred in a 47-year-old woman presenting with epigastric and back pain. The tumor was located in the left hepatic lobe and measured 12 cm in diameter. On immunohistochemical stains, the neoplastic cells were positive for inhibin, as well as cytokeratins 7, 8/18 and 19. There was mild focal expression of synaptophysin, and lack of expression of hepatocytic markers. The histogenesis of hepatic carcinoma expressing inhibin is presently uncertain. From a practical point of view, this neoplasm can potentially cause diagnostic pitfalls by simulating other primary or metastatic tumors, such as hepatocellular carcinoma, cholangiocarcinoma, neuroendocrine tumors, and follicular carcinoma of thyroid gland. Performing inhibin immunostain could assist in the differential diagnosis of liver tumors with unusual histologic features.

Keyword

Carcinoma; Immunohistochemistry; Inhibin; Liver

Figure

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  Fig. 1 Gross and microscopic features of the tumor. (A) Gross examination shows a large, relatively well-circumscribed tumor, with a tan-yellow cut surface and focal areas of hemorrhage and cystic degeneration. (B) Representative low power view of the tumor, demonstrating trabecular, follicular and pseudoglandular architecture. (C) On high power examination, the neoplastic cells are columnar or ovoid, with eosinophilic cytoplasm and mild nuclear pleomorphism. (D) Neoplastic cell invasion of the adjacent hepatic parenchyma is evident at the tumor margin.

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  Fig. 2 Immunohistochemical findings of tumor cells. The neoplastic cells are positive for cytokeratin 7 (A), cytokeratin 19 (B), and inhibin (C). Patchy mild positivity of tumor cells for synaptophysin is also seen (D). Stain for polyclonal carcinoembryonic antigen demonstrates membranous positivity around pseudoglandular structures (E). Ten percent of tumor cells are positive for Ki67 antigen (F). Adjacent hepatic parenchyma is seen on the right side in all photomicrographs except for D.

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  Fig. 3 Immunohistochemical findings of tumor vessels. A rich thin-walled vascular bed is observed on CD34 stain (A), while stain for α-caldesmon shows sparse larger vessels with venous features (B).

Reference

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