Early hepatocellular carcinoma with high-grade atypia in small vaguely nodular lesions.
Early hepatocellular carcinoma with high-grade atypia in small vaguely nodular lesions.
复制标题
DOI：
10.1111/cas.12893
复制
发表时间：
2016-04
期刊：
影响因子：
5.7
通讯作者：
Sakamoto M
中科院分区：
文献类型：
--
作者：
Ojima H;Masugi Y;Tsujikawa H;Emoto K;Fujii-Nishimura Y;Hatano M;Kawaida M;Itano O;Kitagawa Y;Sakamoto M
多步骤肝癌发生从异型增生结节发展到早期肝细胞癌（eHCC）和晚期HCC。本研究的目的是探讨eHCC的详细组织病理学特征。我们研究了40例患者切除的66个小的模糊结节状病变。评估了细胞和结构性增生以及间质浸润的程度。对HCC相关标志物腺苷酸环化酶相关蛋白2（CAP 2）、热休克蛋白70（HSP 70）、Bmi-1、CD 34和h-钙调蛋白的免疫组织化学表达进行了评价。在66个结节中，10个被诊断为低度异型增生结节（LGDN），10个被诊断为高度异型增生结节（HGDN），46个被诊断为eHCC。在46例eHCC中，18个结节（39.1%）显示明显的间质浸润和/或存在硬化成分，并被亚分类为高级别eHCC（HGeHCC）。其余28例eHCC缺乏这些特征，被细分为低级别eHCC（LGeHCC）并进行进一步检查。HGeHCC表现出高水平的细胞和结构损伤以及大的肿瘤尺寸。CAP 2的免疫组化表达和肝窦血管面积从LGDN到HGeHCC显示增加。与其他类型的结节相比，HGeHCC的肿瘤动脉血管密度较高。对这些参数的聚类分析将65个结节细分为HGeHCC主导组、LGeHCC和HGDN主导组以及LGDN主导组。这些结果表明HGeHCC的恶性潜能增加，并表明它已经是向晚期HCC的过渡阶段。我们认为，我们的分级分类系统可能是有价值的，考虑治疗策略的eHCC直径约2厘米。
Multistep hepatocarcinogenesis progresses from dysplastic nodules to early hepatocellular carcinoma (eHCC) and to advanced HCC. The aim of the present study was to investigate the detailed histopathological features of eHCC. We investigated 66 small vaguely nodular lesions resected from 40 patients. The degree of cellular and structural atypia and stromal invasion were assessed. The immunohistochemical expression of HCC‐related markers adenylate cyclase‐associated protein 2 (CAP2), heat shock protein 70 (HSP70), Bmi‐1, CD34 and h‐caldesmon were evaluated. Of the 66 nodules, 10 were diagnosed as low‐grade dysplastic nodules (LGDN), 10 as high‐grade dysplastic nodules (HGDN) and 46 as eHCC. Among the 46 eHCC, 18 nodules (39.1%) showed marked stromal invasion and/or the presence of the scirrhous component and were subclassified as high‐grade eHCC (HGeHCC). The remaining 28 eHCC, which lacked these features, were subclassified as low‐grade eHCC (LGeHCC) and were examined further. HGeHCC showed high levels of cellular and structural atypia and large tumor size. The immunohistochemical expression of CAP2 and the area of sinusoidal vascularization showed increases from LGDN to HGeHCC. The density of arterial tumor vessels was high in HGeHCC compared with other nodule types. Cluster analysis of these parameters subclassified 65 nodules into HGeHCC‐dominant, LGeHCC and HGDN‐dominant, and LGDN‐dominant groups. These results indicate the increased malignant potential of HGeHCC and suggest that it is already a transitional stage to advanced HCC. We consider that our grading classification system may be valuable for considering treatment strategies for eHCC around 2 cm in diameter.