HISTOPATHOLOGICAL AND MORPHOMETRIC ANALYSIS OF ATYPICAL ADENOMATOUS HYPERPLASIA OF HUMAN CIRRHOTIC LIVERS
HISTOPATHOLOGICAL AND MORPHOMETRIC ANALYSIS OF ATYPICAL ADENOMATOUS HYPERPLASIA OF HUMAN CIRRHOTIC LIVERS
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DOI：
10.1007/bf01605457
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发表时间：
1993-05-01
期刊：
影响因子：
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通讯作者：
NAKANUMA, Y
中科院分区：
文献类型：
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作者：
TERADA, T;UEDA, K;NAKANUMA, Y
非典型腺瘤样增生（AAH）是一种发生于肝硬化的增生性实质结节样改变，偶尔可发生明显的肝细胞癌（HCC）。AAH定义为一个相当大的肝细胞结节，伴有不同程度的肝细胞增生，不被认为是HCC，它不同于不存在肝细胞增生的普通腺瘤性增生。在本研究中，我们试图评估癌变过程，并找到组织学变量，表明恶性转化的AAH，使用49手术切除或尸检结节。AAH经常表现出形态异质性。根据总体组织病理学表现，AAH内的非典型病变可分为以下三类：恶性（A）、可疑（B）或非恶性（C）病变。对这三种病变的组合分析表明，B病变出现在C病变之后，A病变最终出现在AAH结节中。在14个组织学变量中，发现核增大、核染色质增多和核轮廓不规则与A病变有很好的相关性。核密度增加、铁抵抗、网硬蛋白纤维减少、透明细胞改变、窦状隙扩张和异常动脉的存在提示A或B病变。 核偏向窦状隙、腺泡和致密排列、脂肪改变和马洛里玻璃样变单独不是A或B病变的有用指标。这些结果表明，AAH是一种癌前病变或边缘性病变，其中明显的HCC可能通过几个步骤演变。虽然肝穿刺活检是诊断良性、可疑和恶性肝细胞结节性病变的有用工具，但应通过考虑AAH的形态异质性和14个组织学变量的可变组合来仔细评估肝穿刺活检标本。
Atypical adenomatous hyperplasia (AAH) is a hyperplastic parenchymal nodular change in the cirrhotic liver, in which overt hepatocellular carcinoma (HCC) occasionally arises. AAH is defined as a sizable hepatocellular nodule with a variable degree of hepatocellular atypia not regarded as HCC, and is different from ordinary adenomatous hyperplasia in which hepatocellular atypia is absent. In the present study, we attempted to evaluate carcinogenetic processes and to find histological variables which indicate malignant transformation in AAH, using 49 surgically resected or autopsied nodules. AAH frequently showed morphological heterogeneity. Atypical lesions within AAHs were divisible into the following three categories from overall histopathological appearances: malignant (A), equivocal (B), or non-malignant (C) lesions. Analysis of combination of these three lesions, which were frequently intermixed in a given AAH, suggested that B lesions appear subsequent to C lesions, and A lesions finally appear in AAH nodules. Among the 14 histological variables, enlargement, hyperchromasia and irregular contour of nuclei were found to correlate well with A lesions. Increased nuclear density, iron resistance, reduction of reticulin fibres, clear cell change, sinusoidal dilatation and presence of abnormal arteries were suggestive of A or B lesions. Nuclear deviation toward the sinusoids, acinar and compact arrangements, fatty change and Mallory's hyaline alone were not useful indicators of A or B lesions. These results indicate that AAH is a preneoplastic or borderline lesion in which overt HCC is likely to evolve through several steps. Although a needle liver biopsy is a useful tool for diagnosis of benign, equivocal and malignant hepatocellular nodular lesions, the needle biopsy specimen should be carefully evaluated by considering the morphological heterogeneity of the AAH and a variable combination of 14 histological variables.