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Background: Hepatocellular carcinoma is the most common primary liver cancer. Pathologic distinction between Hepatocellular Carcinoma (HCC) and adenocarcinoma (Cholangiocarcinoma (CC) and Metastatic Adenocarcinoma (MA)) can be challenging and sometimes requires immunohistochemical panels. Recently, Arginase-1 (ARG-1) and Glypican-3 (GPC-3) have been introduced for differentiation of these tumors.
Objectives: The aim of this study was to determine the diagnostic accuracy of ARG-1 and GLP-3 in differential diagnosis of liver tumors.
Patients and Methods: Eighty-nine formalin-fixed paraffin-embedded tissue blocks including 43 cases of documented HCCs, 19 cases of documented CC, and 27 cases of MA involving the liver (15 colon, 5 stomach, 3 pancreas, 2 gallbladder, 1 duodenum and 1 ampulla of vater) were evaluated for immunohistochemical expression of ARG-1 and GPC-3.
Results: Arginase-1 and GPC-3 demonstrated diffuse staining, as reactivity in > 97% of HCCs, whereas only one (5.3%) and 2 (10.5%) of 19 CC cases show positive staining for GPC-3 and ARG-1, respectively. The expression of both markers in MA showed 6 (22.2%) for ARG-1 and 3 (11.1%) for GPC-3, especially with colorectal origin. Our findings showed a statistically significant difference between ARG-1 and GPC-3 expression in HCC, CC and MA.
Conclusions: The findings of this study reveal that both ARG-1 and GPC-3 are helpful IHC markers to separate HCC from CC and MA. Furthermore, ARG-1 shows 100% sensitivity and 82.6% specificity for the diagnosis of HCC whereas GPC-3 demonstrated 97.7% sensitivity and 91.3% specificity for the diagnosis of this tumor.
Keywords: Arginase; Glypican-3; Hepatocellular Carcinoma; Cholangiocarcinoma; Adenocarcinoma
1. Background
Hepatocellular Carcinoma (HCC) is the most common primary liver cancer. It is the fifth common cancer worldwide and the third leading cause of cancer-related death, after lung and stomach cancers (1).
The distinction of HCC from cholangiocarcinoma (CC) and other types of adenocarcinoma metastatic to the liver is very important. However, in most cases; the correct diagnosis can be made by the combination of clinical findings, imaging modalities and routine evaluation of Hematoxylin and Eosin (H & E) stained sections.
Immunohistochemistry plays a very crucial role in differential diagnosis of liver tumors (2). There are some immunohistochemical markers for identification of hepatocyte origin in routine surgical pathology practice, such as Hepatocyte Paraffin Antigen-1 (HepPar-1), polyclonal Carcinoembryonic Antigen (CEA), CD10, and Alpha-Fetoprotein (AFP) (3). However,...