Utsunomiya Itaru
Department of Pathology, Kurume University School of Medicine, Kurume 830-0011, Japan.
Kurume Med J. 2005;52(4):133-8. doi: 10.2739/kurumemedj.52.133.
Recently, it has been suggested that many of hepatocellular carcinoma (HCC) are of multicentric origin based on the clinicopathologic studies on small HCCs of the early stage and clinical follow-up studies after successful treatments of small HCCs. The author studied the multicentric occurrence of HCC from the point of view of pathomorphology in 168 HCCs less than 3 cm in diameter consecutively resected from 1999 to 2004 and 8 autopsy of liver cirrhosis of micronodular type from 1990 to 2004 at Kurume University Hospital from 1999 to 2004. The association of well-differentiated HCC ranging from 9 mm to 1.2 cm in diameter was found in the non-cancerous tissue of 9 cases (9.5%) among 94 cirrhotic livers. Adenomatous hyperplasia (AH) was found in 7 cases (7.4%). Accordingly, prevalence of synchronous and metachronous multicentric hepatocarcinogenesis was highly suggested in 9.5% and 7.4%, respectively. In 4 (50%) of the 8 autopsy cases of micronodular cirrhosis, however, the coexistence of 2 well-differentiated HCCs around 1.5 cm were found in the different segment. The prevalence of multicentric occurrence in the resected cases is the lowest estimation and true prevalence should be much more higher because HCC cases with multiple nodules are not sent to surgery and the observation is limited in a small area of the subsegmentectomized liver. Indeed, the result of autopsy cases reflects a true prevalence (50%) of synchronous occurrence of HCC.
最近，基于对早期小肝细胞癌（HCC）的临床病理研究以及小HCC成功治疗后的临床随访研究，有人提出许多肝细胞癌起源于多中心。作者从病理形态学角度，对1999年至2004年在久留米大学医院连续切除的168例直径小于3cm的HCC以及1990年至2004年8例小结节型肝硬化尸检病例进行了研究。在94例肝硬化肝脏的非癌组织中，发现9例（9.5%）存在直径9mm至1.2cm的高分化HCC。发现7例（7.4%）存在腺瘤样增生（AH）。因此，强烈提示同步和异时多中心肝癌发生的患病率分别为9.5%和7.4%。然而，在8例小结节性肝硬化尸检病例中的4例（50%），在不同肝段发现了2个直径约1.5cm的高分化HCC共存。切除病例中多中心发生的患病率是最低估计值，实际患病率应该更高，因为有多个结节的HCC病例不会接受手术，且观察仅限于亚段切除肝脏的小区域。实际上，尸检病例的结果反映了HCC同步发生的实际患病率（50%）。
