FINE-NEEDLE ASPIRATION CYTOLOGY OF HEPATIC LEIOMYOSARCOMA

Hepatic leiomyosarcoma is a rare malignancy to involve the liver, occu rring as a primary liver sarcoma in patients without an underlying med ical disorder, as a metastatic malignancy, and with increasing inciden ce, as a primary tumor in AIDS patients. A series of hepatic leiomyosa rcomas diagnosed by FNA biopsy, including the first reported case in a n adult AIDS patient, were reviewed with respect to cytomorphologic fe atures. The series consisted of five men and two women ranging from 24 to 72 years of age. One case was a primary hepatic lesion in a 24-yr- old man with AIDS and six were metastatic from a number of sites (stom ach, small bowel, retroperitoneum, vena cava, and seminal vesicle). Tw o cytologic patterns were identified. Aspirates of spindle-cell leiomy osarcomas (six cases) generally produced hypocellular smears composed primarily of small irregular clusters of cells with blunt-ended, unifo rm, overlapping nuclei. The differential diagnosis included benign rea ctive processes and other benign and malignant spindle-cell neoplasms. The aspirate of an epithelioid leiomyosarcoma (one case) revealed a s econd pattern characterized by highly cellular smears with many single polygonal cells having eccentric, malignant nuclei and a characterist ic clear quality to the cytoplasm in Papanicolaou-stained material. Th is epithelial appearance generated a differential diagnosis that inclu ded hepatocellular carcinoma, metastatic carcinoma, and melanoma. Care ful integration of clinical information, cytomorphologic features, and ancillary studies will allow specific FNA diagnosis of hepatic leiomy osarcoma in most cases. (C) 1994 Wiley-Liss, Inc.