Histological Changes in Hepatocellular Carcinoma Post-locoregional Therapy

Abstract

Locoregional therapies are widely practiced in treatment of primary hepatocellular carcinoma and metastatic carcinoma to the liver as they provide a more targeted treatment with lesser side effects. Transarterial chemo-embolisation and selective internal radiotherapy (SIRT) are a few examples. However, histopathological findings after locoregional therapy of hepatocellular carcinoma are rarely reported. We reported a case of a 61-year-old man with underlying Hepatitis B and subsequent hepatocellular carcinoma who was treated with SIRT followed by wedge liver resection. Macroscopically, the specimen showed a well-defined mass with areas of fibrosis and haemorrhage. Microscopic examination showed 70% tumour necrosis with numerous microspheres surrounded by multinucleated giant cells with histiocytes and chronic inflammatory cells. Currently, the patient is well with regular follow-up. The latest ultrasound findings showed no residual liver lesion in the background of liver cirrhosis. Although assessment of treatment response following locoregional therapy based on histopathological findings are not widely practiced, recognising histopathological changes such as tumour necrosis, provide valuable insight to a patient’s prognosis. Minimal to absent tumour necrosis implies poor response, limiting further locoregional therapy option. Findings of numerous microspheres might pose a diagnostic challenge as they mimic fungal organisms. Hence, histological examination with aid of special stains like periodic acid Schiff (PAS) and Grocott’s methenamine silver stain may be useful.