High-magnification light microscopy of a liver neoplasm stained with Hematoxylin and Eosin. The micrograph shows the fibrolamellar pattern, with thick, lamellar bands of dense, eosinophilic collagen (fibrous stroma) separating broad cords of neoplastic hepatocytes. The tumor cells are large and polygonal, with abundant granular eosinophilic cytoplasm and nuclei that are relatively large with prominent nucleoli. Cell borders are distinct and the architectural pattern resembles trabeculae separated by dense fibrous lamellae. The dense fibrosis produces a parallel, scirrhous-like appearance, contrasted with conventional HCC variants that lack diffuse parallel fibrosis. Immunophenotype is not provided in the image. This histology supports fibrolamellar hepatocellular carcinoma (FL-HCC), a hepatocellular carcinoma variant typically arising in noncirrhotic livers and younger patients, and distinguished from the scar-like scirrhous pattern of typical HCC by the combination of abundant cytoplasmic granularity and orderly fibrous bands. Diagnosis has prognostic and therapeutic relevance, as FL-HCC often exhibits distinct biology and prognosis compared with conventional HCC. This image is valuable for pathology education, morphologic differentiation, and search queries focused on FL-HCC, HCC scirrhous pattern, hepatocellular tumors with fibrous stroma, and high-detail liver histology. Correlate with clinical history, correlate with imaging findings, and consider immunohistochemistry if requested for confirmation.

Histopathology: Light microscopy of a liver tumor with a solid growth pattern consistent with hepatocellular carcinoma (HCC). The specimen is a hepatic parenchymal tissue section stained with hematoxylin and eosin (H&E). Tumor cells form uniform, monomorphic sheets with evenly distributed nuclei, conspicuous nucleoli, and abundant eosinophilic cytoplasm. Bile production is prominent within tumor cells, and portal tracts are absent from the neoplasm, a feature typical of HCC. In this pattern, trabecular arrangements are compressed rather than endothelial cell-wrapped, requiring immunomarkers to highlight residual vascular architecture when necessary. The background liver shows preserved or cirrhotic changes depending on the sample. The differential diagnosis includes conventional trabecular HCC, fibrolamellar variant, and metastatic hepatobiliary tumors; however, the distinct solid sheets and lack of portal triads favor primary liver origin. Clinically, this histology supports a diagnosis of hepatocellular carcinoma, informs prognosis, and guides management, including surgical resection or locoregional therapies and systemic considerations. This image is suitable for pathology education, diagnostic correlation with imaging (CT/MRI), and research on HCC subtypes. Immunophenotype clues (if stained) include HepPar1 and glypican-3 positivity supporting hepatocellular origin; CD34 highlights sinusoidal capillarization in many HCCs; CK19 is typically negative or focally positive in certain variants; clinical correlation remains essential. Interpretation.

Imaging modality: Histopathology; Technique: Hematoxylin and Eosin (H&E) stained section with ancillary iron staining (Prussian blue) to identify hemosiderin. Specimen: Liver tissue, left hepatic lobe. The image demonstrates hepatocellular carcinoma (HCC) with a prominent acinar (pseudoglandular) growth pattern, forming gland-like spaces within malignant hepatocytes and separating from the adjacent native liver parenchyma. The tumor is well-demarcated from surrounding parenchyma, with a crisp interface and abrupt transition. The native liver shows marked hemosiderin deposition, consistent with long-standing hemochromatosis. Hemosiderin appears as brown granular pigment within hepatocytes and can be distinguished from bile by iron stains that yield positive results. The HCC cells are polygonal, with eosinophilic cytoplasm and variable nuclear atypia; architectural pattern includes acinar arrangements resembling glands rather than exclusively trabecular plates. Iron overload is clinically relevant as a widely recognized risk factor for hepatocarcinogenesis. Pathology findings support a diagnosis of iron-overload–associated hepatocellular carcinoma in a liver with iron deposition. Clinically, this morphology has implications for prognosis and therapeutic planning, including consideration of hepatic resection and post-operative surveillance. This image serves as a teaching resource illustrating iron overload, HCC histology, and the utility of iron staining in differentiating hemosiderin from bile.

This diagnostic image series consists of three axial abdominal MRI scans (A, B, and C) illustrating a dynamic contrast-enhanced study of the liver. The focus is a focal liver lesion located in Segment VII, indicated by white arrows, identified as a combined hepatocellular-cholangiocarcinoma (cHCC-CCA). Panel A (Arterial Phase) demonstrates clear arterial phase hyperenhancement (APHE), where the lesion appears hyperintense relative to the surrounding parenchyma. Panel B (Portal Venous Phase) shows the lesion remaining relatively isointense or slightly hyperintense compared to the liver, notably lacking the classic 'washout' often seen in pure hepatocellular carcinoma. Panel C (Delayed/Late Phase) reveals progressive centripetal or gradual contrast enhancement within the lesion, a feature more characteristic of the cholangiocarcinoma component. This comparison chart is an educational tool for distinguishing between primary liver malignancies based on LI-RADS imaging criteria, specifically highlighting how atypical enhancement patterns can suggest a combined histology (cHCC-CCA) rather than isolated HCC.