Clinicopathological studies of minute hepatocellular carcinoma. Analysis of 20 cases, including 4 with hepatic resection.
Clinicopathological studies of minute hepatocellular carcinoma. Analysis of 20 cases, including 4 with hepatic resection.
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微小肝细胞癌的临床病理学研究。
DOI：
10.1016/s0016-5085(19)32281-4
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发表时间：
1977
期刊：
影响因子：
29.4
通讯作者：
Y. Kubo
中科院分区：
文献类型：
--
作者：
K. Okuda;T. Nakashima;H. Obata;Y. Kubo
分析了16例尸检和4例肝切除病例，其中肝脏内有小于4.5 cm的孤立性肝细胞癌，或少数小于3.5 cm的肿瘤结节。临床上，这些患者表现出与肝硬化相符的体征和症状，在 16 例尸检病例中，只有 2 例得到正确诊断。除 4 例外，所有病例的非癌性实质均表现为混合型晚期肝硬化，具有大小不规则的多小叶结节和细丝状间质，与典型的酒精性肝硬化不同。大多数原发病变被严重包裹，表明生长缓慢、扩大。在组织学上，大多数原代细胞分化相对较好。血清甲胎蛋白普遍偏低，仅5例可作为主要诊断线索。对于甲胎蛋白水平轻度异常的患者，持续监测似乎很重要，以便检测其稳定上升，这是肿瘤生长的第一个警告。
Sixteen necropsies and 4 cases of hepatic resection in which the liver had a solitary hepatocellular carcinoma smaller than 4.5 cm, or a few tumor nodules smaller than 3.5 cm, have been analyzed. Clinically, these patients presented with signs and symptoms compatible with cirrhosis and, of the 16 autopsy cases only 2 had been diagnosed correctly. In all but 4 cases, the noncancerous parenchyma showed advanced cirrhosis of the mixed type, with irregularly sized multilobular nodules and thin strands of stroma, different from typical alcoholic cirrhosis. The primary lesion was grossly encapsulated in the majority, suggesting a slow, expanding growth. Histologically, most primaries were relatively well differentiated. Serum a-fetoprotein was generally low, and it served as the major diagnostic clue in only 5 cases. In patients with mildly abnormalα-fetoprotein levels, continuous monitoring seems important in order to detect a steady rise, the first warning for tumor growth.