A strong propensity for vacuolar invasion is seen in
Correct Answer: Hepatocellular carcinoma
Description: Ref Robbins 7/e p925; 9/e p274 Renal and hepatocellular carcinomas hav high tendency invasion of vascular channels MORPHOLOGY HCC may appear grossly as (1) a unifocal, usually massive tumor; (2) a multifocal tumor made of nodules of variable size; or (3) a diffusely infiltrative cancer, permeating widely and sometimes involving the entire liver, blending imperceptibly into the cirrhotic background. Paicularly in the latter two patterns, it may be difficult to radiologically distinguish regenerative cirrhotic nodules from neoplasms of similar size. Discrete tumor masses usually are yellow- white, punctuated sometimes by bile staining and areas of hemorrhage or necrosis. HCC has a strong propensity for vascular invasion. Extensive intrahepatic metastases are characteristic, and occasionally snakelike masses of tumor invade the poal vein (with occlusion of the poal circula- tion) or inferior vena cava, extending even into the right side of the hea. On histologic examination, HCCs range from well- differentiated lesions that reproduce hepatocytes arranged in cords, trabeculae or glandular patterns (Fig. 15-34), to poorly differentiated lesions, often composed of large, multinucleate anaplastic giant cells. In the better-differentiated vari- ants, globules of bile may be found within the cyto- plasm of cells and in pseudocanaliculi between cells. Acidophilic hyaline inclusions within the cytoplasm may be present, resembling Mallory bodies. There is little stroma in most hepatocellular carcinomas, explaining their soft consistency. A distinctive clinicopathologic variant of HCC is the fibrolamellar carcinoma. It occurs in young male and female adults (20 to 40 years of age) with equal incidence and has no association with cirrhosis or other risk factors. It usually consists of a single tumor with fibrous bands coursing through it, superficially resembling focal nodular hyperplasia. The fibrolamellar variant has a better prognosis than that of the other, more common variants.
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