title: Unique morphologic and clinical features of liver predominant/primary small cell carcinoma--autopsy and biopsy case series.
abstract: Liver predominant small cell carcinoma is rare but often presents as hyperacute liver failure with unknown primary and is a medical emergency. We present 2 autopsy and 7 biopsy cases of liver predominant small cell carcinoma and demonstrate that these patients present with liver failure and identifiable hepatomegaly but lack discrete lesions on imaging as well as no mass lesions identified in other organs including lung. Compared with the multiple nodules of metastatic small cell carcinoma in the liver, unique morphologic feature of liver predominant/primary small cell carcinoma in autopsy and biopsy specimens was a diffuse infiltration of small blue neoplastic cells predominantly in the sinusoidal space in the liver parenchyma. Before diagnosing liver predominant/primary small cell carcinoma, other infiltrating small blue cell neoplasms including lymphoma and peripheral neuroectodermal tumor need to be ruled out through immunohistochemistry. We, therefore, demonstrate that liver biopsy together with a rapid panel of immunostains is necessary to firmly establish a diagnosis of liver predominant small cell carcinoma and allow clinicians to immediately implement potentially lifesaving chemotherapy.
authors.affiliation: Department of Pathology, Northwestern University, Chicago, IL 60611.
authors.forename: Amy A
authors.initials: AA
authors.lastname: Lo
authors.affiliation: Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Lo
authors.affiliation: Department of Pathology, Northwestern University, Chicago, IL 60611.
authors.forename: Haonan
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Pathology, Northwestern University, Chicago, IL 60611.
authors.forename: Wanying
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Northwestern University, Chicago, IL 60611.
authors.forename: Jie
authors.initials: J
authors.lastname: Liao
authors.affiliation: Department of Pathology, Northwestern University, Chicago, IL 60611.
authors.forename: M Sambasivia
authors.initials: MS
authors.lastname: Rao
authors.affiliation: Department of Radiology, Northwestern University, Chicago, IL 60601.
authors.forename: Frank
authors.initials: F
authors.lastname: Miller
authors.affiliation: Department of Pathology, Northwestern University, Chicago, IL 60611. Electronic address: g-yang@northwestern.edu.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Yang
mesh_terms: D001344:Autopsy; D001706:Biopsy; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging / Q000473:pathology*; D016208:Databases, Factual; D006529:Hepatomegaly / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D017114:Liver Failure, Acute / Q000000981:diagnostic imaging / Q000473:pathology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: Acute liver failure; Hyperacute liver failure; Small cell carcinoma; hepatomegaly