AMP case report: Isolated hepatic neuroendocrine tumor expressing albumin mRNA and arginase-1, December 2016

1. Shafizadeh N, Kakar S. Hepatocellular carcinoma: histologic subtypes. Surg Pathol Clin. 2013;6(2):367–384.
2. Park CH, Chung JW, Jang SJ, et al. Clinical features and outcomes of primary hepatic neuroendocrine carcinomas. J Gastroenterol Hepatol. 2012;27(8):1306–1311.
3. Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. WHO Classification of Tumours of the Digestive System; vol 3. 4th ed. Lyon, France: IARC Press; 2010.
4. Nakanuma Y, Sato Y, Harada K, Sasaki M, Xu J, Ikeda H. Pathological classification of intrahepatic cholangiocarcinoma based on a new concept. World J Hepatol. 2010;2(12):419–427.
5. Shahid M, Mubeen A, Tse J, et al. Branched chain in situ hybridization for albumin as a marker of hepatocellular differentiation: evaluation of manual and automated in situ hybridization platforms. Am J Surg Pathol. 2015;39(1):25–34.
6. Terris B, Hergli I, Lin-Marq N, Rubbia-Brandt L. Letter to the editor with regard to article titled: “Branched chain in situ hybridization for albumin as a marker of hepatocellular differentiation.” Am J Surg Pathol. 2015;39(8):1156–1157.

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Here are three questions taken from the case report.
Answers are online now at www.amp.org/casereports and will be published next month in CAP TODAY.

1. Which of the following is true regarding primary hepatic neuro­endocrine tumors?

a) They represent the third most common type of primary liver cancer.

b) Features of neuroendocrine differentiation are frequently found in both hepatocellular carcinomas and cholangiocarcinomas.

c) They have a tendency to metastasize to endocrine organs.

d) A neuroendocrine tumor presenting in the liver will prompt an extensive search for a primary tumor site.

e) They are known to arise from neural crest cells that migrate to the liver during embryogenesis.

2. From the case report, which of the following may be inferred regarding branch chain in situ hybridization for albumin mRNA?

a) It has limited utility because of the widespread presence of albumin in serum and interstitial tissue.

b) It requires fresh frozen tissue as a substrate.

c) It has high sensitivity for mRNA detection in routinely fixed paraffin-embedded tissue due to probe tiling and signal amplification.

d) Fluorescence microscopy is required for analysis.

e) The results must be confirmed by protein immunohistochemistry due to mRNA cross-reactivity with pseudo-albumin.

3. Detection of albumin mRNA in a documented neuroendocrine tumor restricted to the liver is suggestive of:

a) contamination by background hepatocytes.

b) contamination by extracellular albumin.

c) the presence of a housekeeping gene common to all neuroendocrine tumors.

d) an incorrect diagnosis.

e) multipotential plasticity of a primary hepatic tumor stem/progenitor cell.

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Dr. Nalesnik is a professor of pathology, Division of Transplantation Pathology, and Dr. Singhi is an assistant professor of pathology, Division of Anatomic Pathology, both in the Department of Pathology, University of Pittsburgh Medical Center.