Fibrolamellar carcinoma versus scirrhous hepatocellular carcinoma : diagnostic usefulness of CD68

Background : Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare variant of hepatocellular carcinoma that commonly affects young individuals without a prior history of liver disease. The principal differential diagnosis is conventional hepatocellular carcinoma especially the scirrhous variant. Despite their distinctive appearance, recent studies have demonstrated a lack of consistency in how FL-HCC are diagnosed by pathologists. Aim : To investigate the diagnostic utility of CD68 in differenti- ating between FL-HCC and scirrhous hepatocellular carcinoma. Patients and Methods : In our retrospective study, we reviewed four cases of FL-HCC that were diagnosed at the pathology depart- ment of Mongi Slim hospital over a thirteen-year period (2002- 2014). Relevant clinical information and microscopic slides were available in all cases and were retrospectively reviewed. Immuno- histochemical analysis was performed using the avidin-biotin complex technique with antibodies against CD68 and CK7. Results : Our study group included one man and three women (sex ratio M/F = 0.33) aged between 23 and 34 years (mean = 28 years). All cases arose in non-cirrhotic liver. Immunohisto- chemically, all cases were positive for CK7 and for CD68 (n = 4). Conclusions : CD68 immunostaining is a sensitive marker for FL-HCC that may be of use in routine diagnostic surgical patholo- gy. Lack of CD68 staining should suggest caution in making a diag- nosis of FL-HCC. (Acta gastroenterol. belg., 2015, 78, 393-398).