FIGURE 3.

Histopathologic examination of core liver biopsy (A) shows liver parenchyma largely replaced by neoplastic cells infiltrating in nests and single cells with epithelioid to spindled morphology. Cytologic features include variation in nuclear size and shape with stippled chromatin, intranuclear inclusions, relatively low mitotic rate, and necrosis. Immunostains were positive for chromogranin (B) and calcitonin (C) secretion, consistent with metastatic medullary thyroid carcinoma. Nonneoplastic liver biopsy (not shown) was remarkable for fibrosis and nodularity suggestive of cirrhosis and negative for increased iron. Cytologic impression for fine-needle aspiration of right thyroid nodule also showed medullary thyroid cancer.