Sakamoto M, Hirohashi S, Shimosato Y
Pathology Division, National Cancer Center Research Institute, Tokyo, Japan.
Hum Pathol. 1991 Feb;22(2):172-8. doi: 10.1016/0046-8177(91)90039-r.
From a series of 320 heptocellular carcinoma (HCC) cases treated surgically, we selected small nodular lesions that had not destroyed the preexisting liver structure grossly. After excluding metastases and large regenerative nodules, 58 lesions from 41 cases were chosen. All the lesions were hypercellular. Among them, 33 lesions showing histologic features of very well-differentiated HCC (Edmondson grade I), that is, small hepatocytes with little cellular atypia but with structural atypia, such as a thin trabecular structure of acinar formation in some areas, were classified as early HCC (eHCC). In seven eHCCs, areas of overt carcinoma, classified as Edmondson grade II, were found in the background of Edmondson grade I carcinoma. The remaining 25 lesions lacked structural atypia and were classified as adenomatous hyperplasia (AH). Among the AHs, 10 nodules with a very focal abnormal structure were subclassified as atypical adenomatous hyperplasia (AAH). There was a tendency for the size and cellularity of the atypical lesions to increase in order from AH to AAH to eHCC. All nodules larger than 1.5 cm were eHCC. A degree of cellularity more than twice that of a regenerative nodular was suggested to be an indicator of HCC. All small nodular lesions were associated with chronic liver disease. These histologic observations appear to explain the stepwise development of overt HCC from very well-differentiated eHCC, and of eHCC from AH probably through AAH, at least in cases of HCC associated with chronic liver disease.
在一组320例接受手术治疗的肝细胞癌（HCC）病例中，我们选择了肉眼未破坏原有肝脏结构的小结节性病变。在排除转移瘤和大的再生结节后，从41例患者中选取了58个病变。所有病变均细胞增多。其中，33个病变具有高分化HCC（Edmondson I级）的组织学特征，即小肝细胞，细胞异型性小但有结构异型性，如某些区域有薄的小梁结构或腺泡形成，被归类为早期HCC（eHCC）。在7例eHCC中，在Edmondson I级癌的背景中发现了被归类为Edmondson II级的明显癌灶。其余25个病变缺乏结构异型性，被归类为腺瘤样增生（AH）。在AH中，10个具有非常局灶性异常结构的结节被亚分类为不典型腺瘤样增生（AAH）。非典型病变的大小和细胞数量有从AH到AAH再到eHCC逐渐增加的趋势。所有大于1.5 cm的结节均为eHCC。细胞数量比再生结节多两倍以上被认为是HCC的一个指标。所有小结节性病变均与慢性肝病有关。这些组织学观察结果似乎解释了至少在与慢性肝病相关的HCC病例中，从高分化的eHCC发展为明显HCC的逐步过程，以及从AH可能通过AAH发展为eHCC的过程。
