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Immunohistochemical of diagnostic algorithms neoplastic liver biopsies

Rani Kanthan

 Pathological analysis and evaluation of a liver biopsy is an important step in the diagnosis of single or multiple mass lesions in the liver. Accurate diagnosis is paramount in guiding appropriate treatment. This study conducted a search for liver biopsies for the past 6 years with the diagnostic search codes of neoplasm, metastases, metastatic, adenocarcinoma, neuroendocrine carcinoma, sarcoma, and lymphoma. The aim was to review their pathological workup with a view to developing cost-efficient immunohistochemical diagnostic algorithms. A total of 375 consecutive neoplastic liver biopsies were retrieved and subjected to pathological review. As expected the majority up to 95% of the neoplastic lesions were metastatic lesions. A few biopsies up to 1% represented primary hepatocellular /cholangiocarcinoma, haemangioma, and cirrhosis. The commonest metastases [upto 61%] to the liver were colorectal in origin being Hepar-ve, CDX2+ve, and CK20+/CK7-ve. Other lesions included metastases from pancreas [12%], lung [8%] upper gastrointestinal [8%], neuroendocrine lesions [8%], ovarian [1%] and kidney/urothelial [2%]. Uncommon metastases encountered included hepatic metastatic meningioma, endometrial stromal sarcoma, and osteosarcoma. Immunohistochemical stains were the most useful test in identifying the primary site of the tumor. Though diagnostic algorithms were developed especially in the case of the unknown primary, some biopsies received a differential diagnosis of more than one organ as the primary site for clinicopathological correlation.