Often the radiologists will first perform FNA with on-site evaluation of adequacy by the cytologist and end the procedure with a final core biopsy specimen. There are instances where the FNA contains abundant diagnostic material but the tissue biopsy is non-diagnostic and vice-versa. For hilar lesions of the liver, brushings obtained at the time of ERCP and endoscopically guided FNA are the preferred methods to obtain diagnostic material. Complications of FNA are rare, hemorrhage, hematoma

formation, bile peritonitis, pneumothorax, Gram-negative sepsis and tumor Inhibitors,research,lifescience,medical seeding has been reported. These complications are less than those reported for wider bore Inhibitors,research,lifescience,medical biopsies (5-6). Contraindications include refractory bleeding diathesis, uncooperative patient, massive ascites, severe emphysema, suspected hydatid cyst (as rupture may precipitate an anaphylactic reaction). Cytology is less useful in diagnosing specific localized non neoplastic and benign liver lesions, but is nevertheless helpful in excluding a malignant process. Sample preparation Aspirate smears should be made rapidly to avoid clotting artifacts, which will seriously compromise the cytologist’s rendering of a complete

and accurate diagnosis. Inhibitors,research,lifescience,medical Diff-Qiuk stain on air dried smears or Toluidin Blue on alcohol fixed smears may be used to immediately assess the quality of the biopsy. Cell blocks prepared from rinsing the FNA needle after smear preparation as well as harvesting the entire contents of one or more FNA passes are extremely helpful. Several reasonably sized (0.5 to 1 mm) fragments of

tissue should be obtained for cell block. If concomitant core biopsy specimens are Inhibitors,research,lifescience,medical obtained they should be processed separately. Normal liver Needle aspirates of normal liver consist predominantly of Inhibitors,research,lifescience,medical hepatocytes, with admixed biliary epithelial cells, Kupffer cells and endothelial cells. The hepatocytes are present as single cells, or monolayered small cell groups and sheets. The cells are round, polygonal, have well defined cell borders, and granular dense cytoplasm. Hepatocytes frequently contain cytoplasmic pigments (lipofuscin, hemosiderin, bile pigment, copper). The hepatocyte nucleus is round/oval, with smooth nuclear contour, fine evenly dispersed chromatin, and conspicuous nucleolus. There may be mild anisonucleosis (in extreme Cilengitide uniformity a well-differentiated neoplasm needs to be excluded). Scattered binucleation may be present. Numerous intranuclear inclusions are seen in Diabetes Mellitus and Wilson’s disease. Bile duct cells are sparse in normal liver aspirates. They appear as monolayer sheets of uniform columnar to cuboidal cells with evenly spaced nuclei (“honeycomb appearance”). Bile ductal cells have less cytoplasm than hepatocytes, and contain round to oval nuclei with indistinct nucleoli (Figure 1).