Pathologic and molecular biologic diagnosis of multicentric hepathocellular carcinoma and treatment for such carcinoma

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We evaluated clinicopathologic criteria for multicentric hepatocellular carcinoma (HCC) and identified risk factors for such carcinogenesis. One kind of multicentric HCC had at least one tumor consisting of well differentiated HCC, together with moderately or poorly differentiated HCC located in a separate region. The other kind had an area of well differentiated component around HCC with less differentiated in all occurrence. The risk factors include past history of blood transfusion, high value of 15-min indocyanine green retension test, high alanine aminotransferase activity, hyper-bilirubinemia, hepatitis C virus infection with or without past infection of hepatitis B virus. The risk increases as the progress in active hepatitis and hepatic fibrosis. Analysis of patterns of X-chromosome inactivation was useful for differentiation of multicentric carcinogenesis from intrahepatic metastasis. The cumulative survival rate was significantly higher in patients with multicentric HCCs than in patients with intrahepatic metastasis. The risk factors for multicentric reccurrence include low platelet count. The strategy for treatment for HCC should be based on the potential for hepatocarcinogenesis estimated by such risk factors.