Roncalli Massimo
Department of Pathology, University of Milan, Istituto Clinico Humanitas of Rozzano, Milan, Italy.
Liver Transpl. 2004 Feb;10(2 Suppl 1):S9-15. doi: 10.1002/lt.20047.
The spectrum of so-called space-occupying small (0.5-2.5 cm) sizable nodules arising in the cirrhotic liver includes a series of hyperplastic (large regenerative), dysplastic (low- and high-grade dysplastic), and malignant hepatocellular (well-differentiated hepatocellular carcinoma, HCC) nodules. Major progress in their classification and understanding was achieved through image analysis techniques and careful histological dissection of explanted native livers. Needless to say, the actual understanding of their natural history is crucial to a proper histological classification. The differential diagnosis of these hepatocellular nodules is difficult, particularly on biopsy specimens of focal liver lesions revealed by ultrasound (US), taken during the follow-up of cirrhotic patients. In this study we attempted to summarize, on the basis of our experience, essential clinicopathological features useful to distinguish the different nodules on needle biopsy. Synoptic tables of differential diagnosis and figures of elementar lesions, which have to be looked for, are provided. Only the continuous integration of clinical features, image analysis information of pathological findings, and follow-up data allows establishing the autonomy of these polymorphic and controversial entities and the boundaries between them.
在肝硬化肝脏中出现的所谓占据空间的小（0.5 - 2.5厘米）大小的结节谱系包括一系列增生性（大再生性）、发育异常性（低级别和高级别发育异常）以及恶性肝细胞性（高分化肝细胞癌，HCC）结节。通过图像分析技术以及对切除的天然肝脏进行仔细的组织学剖析，在它们的分类和理解方面取得了重大进展。不用说，对它们自然史的实际理解对于恰当的组织学分类至关重要。这些肝细胞结节的鉴别诊断很困难，尤其是在对肝硬化患者随访期间通过超声（US）发现的局灶性肝病变的活检标本上。在本研究中，我们试图根据我们的经验总结出对针吸活检中区分不同结节有用的基本临床病理特征。提供了鉴别诊断的一览表以及必须查找的基本病变的图示。只有临床特征、病理结果的图像分析信息和随访数据的持续整合，才能确定这些多态性且有争议的实体的自主性以及它们之间的界限。
