Fine-needle aspiration cytology and cell block in diagnosis and subtyping of hepatoblastoma

Hepatoblastoma (HB) constitutes less than 1% of all pediatric malignancies and is the most common malignant tumor of liver in children. The fine-needle aspiration cytological (FNAC) diagnosis and sub-typing of this tumor is challenging, which is of critical importance from its treatment point of view. All cases with a clinicoradiological impression of "HB" during the study period of 1 year were subjected to ultrasound-guided (USG) FNAC and cell blocks were prepared in all cases. Detailed cytopathological examination was carried out based on the cytomorphological pattern and the cell blocks were used to correlate the findings and the final diagnoses were confirmed with the histopathological findings. Four cases were included during this study period. All were children, whose age ranged from 3 months to 10 years. All of them presented with mass per abdomen and increased serum alfa-feto protein (AFP) levels. On a detailed cytological examination, the clinical impression of HB was confirmed in all four cases with a subsequent histological correlation. Based on their distinct cytomorphological pattern, three of them were accurately sub-typed as"fetal type," wile the fourth was an "embryonal type of HB." All four cases had the evidence of extramedullary hematopoeisis. We conclude that a precise preoperative FNAC diagnosis with accurate sub-typing of HB is possible purely on cytomorphologic basis which has prognostic and therapeutic implications. Cell blocks are of great use for ancillary studies. Extramedullary hematopoiesis serves as an important "clue" in diagnosis.