Fine needle aspiration cytology of metastatic hepatic adrenocortical carcinoma mimicking hepatocellular carcinoma - A case report

BACKGROUND: Adrenocortical carcinoma (AC) is a rare neoplasm, usually consi dered one of the most morbid arid lethal human tumors. It occurs primarily in children and young adults and often presents with advanced and/or metast atic disease. CASE: A 9-year-old boy with a previous diagnosis of adrenocortical carcinom a underwent computed tomography (CT)-guided fine needle aspiration (FNA) fo r preoperative investigation of a hepatic mass. All smears revealed abundan t groups of cells surrounding an interconnective, thin-walled, central vasc ular core. These cells showed finely vacuolated, large cytoplasm with eccen trically placed nuclei. Occasionally, cells underwent a sudden, marked incr ease in size, with prominent atypia. Multinucleated, atypical giant cells a nd high mitotic rate were also evident. The cytologic findings resembled th e previous histologic adrenocortical carcinoma features. CONCLUSION: The cytologic features of metastatic hepatic adrenocortical car cinoma may mimic those of hepatocellular carcinoma. However, the presence o f atypical multinucleated and pleomorphic cells with microvacuolated cytopl asm and eccentric as well as the absence of naked nuclei and endothelial li nings yield the diagnosis of adrenocortical carcinoma. Nevertheless, other space-occupying liver lesions in children must also be considered. This cas e demonstrates the usefulness of CT-localized FNA biopsy in hepatic masses in children and discusses the possible cytologic differential diagnosis.