Hepatocellular carcinoma: Clinicopathological aspects
Hepatocellular carcinoma: Clinicopathological aspects
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DOI：
10.1111/j.1440-1746.1997.tb00515.x
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发表时间：
1997-10-01
影响因子：
4.1
通讯作者：
Okuda, K
中科院分区：
文献类型：
--
作者：
Okuda, K
肝细胞癌（HCC）的组织病理学和临床表现在个体患者和地区之间存在差异，这些差异可能是由于肝癌发生前的遗传改变的差异。在这项研究中，南部非洲黑人和日本人之间的HCC的临床病理特征进行了比较，表明潜在的肝硬化，癌细胞分化和临床过程的级别的频率有很大的差异。腹腔内出血和发热、快速进展的HCC在黑人中更常见。这种差异的部分原因是由于在日本，分化良好的肿瘤经常被包裹，并且以扩张的方式缓慢生长。在研究的黑人患者中未观察到包膜型HCC。本文讨论的其他不同的临床病理类型包括弥漫型肝癌，它通常是由多个门脉扩散引起的，几乎同时发生，临床过程是暴发性的。在美国，硬化性癌常与高钙血症相关，但在日本则不然。纤维板层癌在亚洲几乎不存在，而在西方年轻人中很常见。其预后一般好于普通HCC。肝细胞癌有很强的侵袭血管和导管系统的倾向。门静脉侵犯虽可加重门静脉高压症，但临床症状不明显。肿瘤阻塞主要门静脉的患者在终末期前血压突然下降时可能引起缺血性肝炎。肝实质出现亚大块坏死，临床上丙氨酸氨基转移酶（ALT）急性升高。也会发生肝大静脉和下腔静脉的侵犯，但与门静脉侵犯相比，其发生率较低。即使心房内的肿瘤血栓穿过三尖瓣，患者也可以存活。胆管内侵犯可引起急性黄疸，偶尔也可引起疼痛性胆道出血。我们最近发现，一种独特的病理类型称为“肝外生长”或“有蒂肝癌”的发展，作为融合的结果，右侧肾上腺转移的肝癌和肝脏，可能通过“肾上腺-肝融合”，这是相当常见的在肾上腺皮质增生的肝脏。
The histopathology and clinical picture of hepatocellular carcinoma (HCC) varies between individual patients and regions, These variations are perhaps due to differences in the genetic alterations that precede hepatocarcinogenesis. In this study, the clinicopathological features of HCC were compared between southern African blacks and Japanese, indicating large differences in the frequency of underlying cirrhosis, grade of cancer cell differentiation and clinical course. Intra-abdominal bleeding and febrile, rapidly progressive HCC are more common among blacks. Such a difference is accounted for, in part, by frequent encapsulation of the tumour which is well differentiated, and grows slowly in an expanding fashion in Japan. Encapsulated HCC was not seen among the black patients studied. Other distinct clinicopathological types discussed in this paper include diffuse-type HCC which is usually caused by multiple portal spread occurring almost simultaneously the clinical course is fulminant. Sclerosing carcinoma is frequently associated with hypercalcaemia in the United States, but not in Japan. Fibrolamellar carcinoma is nearly non-existent in Asia, whereas it is common among young adults in the West. Its prognosis is generally better than ordinary HCC. Hepatocellular carcinoma has a strong propensity to invade vessel and duct systems. Portal invasion does not produce distinct clinical signs although it may aggravate portal hypertension. Patients with tumour occlusion in the major portal vein may give rise to ischaemic hepatitis when blood pressure drops suddenly in the preterminal stage. Liver parenchyma develops submassive necrosis and clinically there is an acute rise in alanine aminotransferase (ALT). Invasion into a major hepatic vein and the inferior vena cava also occurs, but less frequently compared with portal invasion, The patient can live even with a tumour thrombus in the atrium crossing the tricuspid valves. Intraductal invasion causes acute jaundice as well as an occasional haemobilia with pain. We recently found that a distinct pathological type called 'extrahepatic growth' or 'pedunculated HCC' develops as a result of fusion of right-sided adrenal metastasis of HCC and the liver, perhaps through the 'adreno-hepatic fusion' which is rather common in cirrhotic livers.