HISTOPATHOLOGICAL CHARACTERISTICS OF THE EARLY STAGE AND ONCOGENOUS EXPRESSION IN PRIMARY HEPATOCELLULAR CARTINOMA

早期诊断和治疗是改善肝细胞癌预后的关键，但其早期病理形态尚不清楚。在472例肝细胞癌切除病例中，对111例直径小于3 cm的小肝癌和23例直径小于2 cm的微小肝癌进行了细胞形态学、免疫组织化学、细胞核DNA分析和细胞癌基因表达的流式细胞术研究。1)在非癌区的组织学上，不仅观察到了完全性的B型肝炎，而且还观察到了相当数量的从慢性肝炎到B型肝硬变的癌前病变。2)微小肝癌包膜外侵犯占60%，肝内转移占25%。即使当肿瘤直径小于2厘米时，也能观察到相当大的进展。轻度或轻度肝硬变的肝细胞癌，其INVAS…的发生率较低。3)小肝癌主要由EDI和II型分化细胞组成。4)在远离主瘤的区域，可见无包膜、边界不清的微小子体肿块，由较小的、增殖性肝细胞组成，常称为腺瘤性增生。然而，这微小的肿块在细胞学上显示高的N/C比，虽然在免疫组化中显示阴性的肿瘤标志物，但通常有小的肝细胞癌病灶。因此，我们认为这个微小的病灶确实是UCC.5的早期病变)在DNA倍体中，小肝癌表现出明显高于大肿瘤的二倍体模式。6)在癌基因表达中，C-myc、C-Ha-ras、N-ras 5个癌基因。17例肝细胞癌进行了LCA和C-fos检测，N-ras和C-myc几乎全部升高。7)早期肝细胞癌的形态特征是高度分化的细胞形态特征，与正常肝细胞相差不大。较少

Early diagnosis - treatment is essential for improving the prognosis of hepatocellular carcinoma (HCC) However, the Pathomorphology of this disease in the early stage has hardly be elucidated.In the totally 472 resected cases of HCC, 111 cases of small liver cancer(less than 3cm in diameter) containing of 23 cases of minute liver cancer(less than 2 cm in diameter) were investigated by cytomorphological analysis, immunohistochemical study, flow cytometric study on nuclear DNA analysis and expression of cellular oncogenes.1)In the histology of non-cancerous region not only completed cirrhosis of type B but also a precirrhotic lesion from chronic hepatitis to type B'cirrhosis were observed in a considerable number, especially in large liver cancers.2)Minute liver cancers showed extracapsular invasion in 60%, intrahepatic metasis in 25%. Considerable advance was observed even when the tumor was less than 2cm in diameter. The HCC with slight or mild cirrhosis revealed the low rates of invas … More ion and metastasis.3)Small liver cancer consisted primarily of differentiated cells of Ed I and II types.4)In the distant areas from main tumors, minute daughter masses with no capsule and poorly defined border, consisting smaller, proliferative hepatocellular-cells were observed, and this lesions have been frequently called adenomatous hyperplasia. However, this minute mass showed high N/C ratio in the cytometry, and often had small foci of HCC, though showing negative tumor makers in the immunohistochemistry. Therefore we consider this minute focus to be, indeed, the early lesion of UCC.5)In the DNA ploidy, small liver cancers showed a significantly higher rate of diploid pattern compared with large tumors.6)In the oncogenous expression, 5 oncogenes of C-myc, C-Ha-ras, N-ras. lca and C- fos were examined in 17 HCC, and N-ras and C-myc were elevated in nearly all cases. However no oncogenous expression were detected in the minute cancers.7)The morphology of a early stage of HCC was suggested to be highly well-differentiated cytomorphologic features that show few deviations from normal liver cells. Less