58-year-old male used to work in a chemical plant where he was involved in the synthesis of vinyl chloride (specimen from autopsy).
- Tumor cells grow along pre-existing vascular channels (sinusoids, portal vein branches).
- Sinusoids are focally dilated and lined by spindle-shaped, rounded or irregular eosinophilic cells with hyperchromatic nuclei. The latter may be elongated or irregular in shape.
- Sinusoidal growth of tumor cells leads to atrophy of neighboring liver cells.
- Blood-filled caverns surrounded by a thick, fibrotic wall are lined by sarcoma cells.
- In some areas solidly packed tumor cells arranged in a herring-bone pattern are distinguished, reminiscent of a fibrosarcoma.
- Extensive areas of necrosis.
- Remaining liver parenchyma with ductular hyperplasia along portal tracts. Focal hyperplasia of liver parenchyma. Thrombosis in a branch of the portal vein.
Tumor cells express factor VIII-related antigen by immunohistochemistry, in accordance with their endothelial phenotype. CD31 and CD34 are two additional useful markers.
Macroscopy: The liver is diffusely enlarged and pervaded by multiple in part grayish-white in part red-brown hemorrhagic tumor nodules.