Abstract

A 55 year old male complain right shoulder pain and right upper quadrant pain about three months. He was a heavy alcoholism. Highly selective angiography, CT scan and operation findings suggest primary malignant neoplasm of the liver. Right hepatic lobectomy and partial diaphragmectomy was done under impression of heaptocellular carcinoma. The specimen measured 15x11x9 cm and disclose relatively hard and nodular mass devoid of cirrhotic changes. Cut surface show unilobar large mass measuring 11x8x6 cm and bearing brightly yellow discoloration and multifocal hemorrhagic necrosis. Histological characteristics were diffuse proliferation of large neoplastic cells with ample cytoplasm, containing granular materials, erythrophagocytosis, neutrophagocytosis and hemosiderin pigments. Atypical and bizarre mitosis and multinucleated giant cells bearing abundant erythro and neutrophagocytosis were frequently seen. The large or vesicular nuclei were irregular, with occasional deep indentations and revealed sharply defined nuclear membrane, coarse chromatin and conspicious nucleoli. Ultrastructurally the cytoplasm of neoplasltic cells had lysosomal granule, phagolysosome, phagocytized material and residual bodies. Immunohistochemical stains for alpha 1-antitrypsin, alpha 1-antichymotrypsin, vimentin and lysozyme showed positive reactions, but, alpha fetoprotein, cytokeratin, S-100 protein, factor VIII, complement 3 receptor and carcinoembryonic antigen were negative. Alpha-naphtyl acetate esterase activity in paraffin embedded tissue ribbon showed negative reaction. These findings show compatible with primary malignant lymphoma, true histiocytic type, (histiocytic sarcoma, Kupffer cell carcinoma) of the liver.

• Keywords: Primary kupffer cell sarcoma;Liver;