title: Medullary-like hepatocellular carcinoma: an unusual histologic variant.
abstract: OBJECTIVE
  Due to differences in prognosis and management, it is important to subclassify hepatocellular carcinoma (HCC). We encountered an unusual case of HCC with features not typical of the previously described subtypes that was composed of a markedly cellular background consisting of plasma cells and lymphocytes.
  
  
  METHODS
  Review of the literature revealed a single prior case report describing a lesion with similar histology.
  
  
  RESULTS
  In contrast to the previous case report suggesting a less aggressive course and a lesion with increased apoptotic activity, our patient died as a result of his disease within 30 days of diagnosis. In this report, we compare the features of our case with the previously described lesion and use immunohistochemistry for cleaved caspase 3 to evaluate apoptosis and mismatch repair proteins to evaluate microsatellite instability.
  
  
  CONCLUSIONS
  This report is presented to increase awareness of this unusual lesion and because it raises questions regarding the previous claim suggesting a less aggressive clinical course.
authors.affiliation: From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, and erin.quist@unmc.edu.
authors.forename: Erin
authors.initials: E
authors.lastname: Quist
authors.affiliation: From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, and.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Talmon
authors.affiliation: Dr Hartman Family Practice Clinic, North Platte, NE.
authors.forename: Cleve
authors.initials: C
authors.lastname: Hartman
authors.affiliation: From the Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, and.
authors.forename: James
authors.initials: J
authors.lastname: Wisecarver
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D053843:DNA Mismatch Repair / Q000235:genetics; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D008297:Male; D053842:Microsatellite Instability; D011379:Prognosis
keywords: Hepatocellular carcinoma; Hepatopathology; Medullary-like hepatocellular carcinoma