A 50-year-old man undergoes liver biopsy for a hepatic mass in cirrhosis. Histology shows nuclear pleomorphism and atypical mitoses. Which single feature on reticulin stain MOST reliably distinguishes HCC from a large regenerative nodule?
- A Loss of reticulin framework — disruption or absence of reticulin fibers ✓
- B Presence of bile within tumor cells
- C Nuclear-to-cytoplasmic ratio greater than 0.5
- D Presence of Mallory-Denk bodies
Correct answer: A. Loss of reticulin framework — disruption or absence of reticulin fibers
Explanation
The most reliable histological criterion distinguishing HCC from regenerative nodules is loss of the reticulin framework on reticulin stain, reflecting disruption of normal hepatic sinusoidal scaffolding. Regenerative nodules maintain their reticulin network. Bile production and Mallory bodies can occur in both settings; increased N:C ratio alone is insufficient for malignancy diagnosis.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.