J Liver Cancer.  2023 Mar;23(1):219-224. 10.17998/jlc.2023.02.24.

Adult hepatoblastoma: making the challenging distinction from hepatocellular carcinoma

• Pagarigan AKL
• Mendoza PGL

• KMID: 2540835
• DOI: http://doi.org/10.17998/jlc.2023.02.24

Abstract

Hepatoblastoma is an exceptionally rare malignancy in adults with just over 70 non-pediatric cases reported in literature. Recounted is a case of a 49-year-old female who presented with acute right upper quadrant abdominal pain, elevated serum alpha fetoprotein and a large liver mass on imaging. Hepatectomy was performed under clinical suspicion of hepatocellular carcinoma. Immunomorphologic characteristics of the tumor proved consistent with hepatoblastoma of mixed epithelial and mesenchymal type. Hepatocellular carcinoma remains to be the primary differential diagnosis for adult hepatoblastoma, however, distinguishing between these two neoplasms requires close histomorphologic assessment and immunohistochemical profiling as clinical, radiologic and gross pathologic findings typically overlap. Making this distinction is highly crucial in the timely initiation of surgical and chemotherapeutic interventions for this inherently aggressive and rapidly fatal disease.

Keyword

hepatoblastoma; Carcinoma, hepatocellular; Pathology, surgical; Immunohistochemistry; Liver cancer

Figure

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  Figure 1. Adult hepatoblastoma, mixed epithelial and mesenchymal type (A) fetal, crowded (mitotically active) pattern (hematoxylin and eosin [H&E], ×600). (B) Embryonal pattern (H&E, ×600). (C) Macrotrabecular pattern (H&E, ×400). (D) Cholangioblastic pattern (H&E, ×600). (E) Fetal pleomorphic pattern (H&E, ×600). (F) Osteoid formation (H&E, ×400).

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  Figure 2. Adult hepatoblastoma, immunohistochemistry. (A) Hepatocyte paraffin 1, cytoplasmic expression in fetal pattern (×600). (B) Glypican 3, coarse granular expression in fetal pattern (×600). (C) β-catenin, nuclear expression in fetal pattern (×600). (D) Cytokeratin (CK) 7, cytoplasmic expression in cholangioblastic pattern (×600). (E) CK19, cytoplasmic expression in cholangioblastic pattern (×600). (F) CK5/6, negative expression in neoplastic cells (×400).

Reference

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