Radiofrequency ablation causes 'thermal fixation' of hepatocellular carcinoma: a post-liver transplant histopathologic study
Radiofrequency ablation causes 'thermal fixation' of hepatocellular carcinoma: a post-liver transplant histopathologic study
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DOI：
10.1034/j.1399-0012.2003.00062.x
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发表时间：
2003-08-01
影响因子：
2.1
通讯作者：
Sielaff, TD
中科院分区：
文献类型：
--
作者：
Coad, JE;Kosari, K;Sielaff, TD
射频消融（RFA）越来越多地用于治疗等待肝移植的肝细胞癌（HCC）患者。尽管其使用越来越多，详细的组织学信息是罕见的射频治疗病变的性质。我们确定了四名慢性丙型肝炎患者，他们在肝移植前进行了肝癌RFA。对于这四名患者，我们对其肝脏中的治疗病变进行了详细的组织病理学分析。5处病变包括RFA后即刻（4天）和长期（14个月）标本。在5处病变中，4处完全消融。一个不完全消融的病变也接受了化疗栓塞治疗。在RFA后急性期，病变外边界出现间质性出血区。与经典的组织坏死不同，治疗后的病变均显示“热固定”，组织结构和显微镜下细胞细节得以保留。细胞染色特征随时间褪色，但经处理的组织变脆，抵抗组织分解，并产生最小的伤口愈合反应。在病变的外围，坏死肝脏的纤维间隔和血管结构似乎可以划分或限制消融前沿的进展。在消融区边缘周围形成了一个狭窄的细胞减少的纤维边界，伴有局灶性“异物”巨细胞型反应。因此，RFA可以对具有适当肝脏边缘的选定病变进行立即和完全的热固定，并可以在肝移植前为选定的HCC患者提供令人满意的治疗选择。
Radiofrequency ablation (RFA) is increasingly used to treat hepatocellular carcinoma (HCC) in patients awaiting a liver transplant. Despite its increasing use, detailed histologic information is scarce regarding the nature of RFA-treated lesions. We identified four chronic hepatitis C patients who had RFA of their HCC before their liver transplant. For these four patients, we conducted a detailed histopathologic analysis of the treated lesions in their explanted livers. The five lesions included immediate (4 d) and long-term (14 months) post-RFA specimens. Of the five lesions, four were completely ablated. The one incompletely ablated lesion was also treated with chemoembolization. In the acute post-RFA period, a zone of interstitial hemorrhage occurred at the outer boundary of the lesion. Differing from classic tissue necrosis, the treated lesions all showed 'thermal fixation', with preserved tissue architecture and microscopic cellular detail. The cellular staining characteristics faded with time, but the treated tissue became brittle, resisted tissue breakdown, and generated a minimal wound healing response. At the periphery of the lesion, the fibrous septae of the cirrhotic liver and vascular structures appeared to demarcate or limit progression of the ablation front. A narrow hypocellular fibrous boundary with a focal 'foreign body' giant cell-type reaction developed around the edge of the ablation zone. Thus, RFA can produce immediate and complete thermal fixation of select lesions with an appropriate liver margin and can provide a satisfactory treatment option for select HCC patients before a liver transplant.