Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Hepatol Res. 2009 Feb;39(2):143-8. doi: 10.1111/j.1872-034X.2008.00443.x. Epub 2008 Nov 25.
Hepatocellular carcinoma (HCC) arising from the end stages of liver cirrhosis is a fair indication for liver transplantation (LT). To pathologically investigate the multicentric occurrence of relatively early staged HCC in cirrhosis, we studied whole explanted livers.
Fourteen explanted livers from patients undergoing living donor LT (LDLT) were examined. The stage of the HCCs was judged to be within the Milan criteria (M-C; a single HCC less than 5 cm or three HCCs less than 3 cm). Histological examination was performed using serially sectioned specimens 5-7 mm in width. Characterization of preoperatively detectable and undetectable lesions was also performed.
In nine patients (64.3%), a total of 34 nodules were found after whole liver histological examination (WLHE). In five patients (31%), the results exceeded the M-C. The characteristics of undetectable HCCs included a minute (median size 6 mm), well-differentiated appearance (80%), with indistinct margins (85.3%) and without vascular invasion (94%). There was no recurrence in any patients at the time of follow up (median follow-up period, 30.1 months).
A multicentric occurrence of HCCs was demonstrated in cirrhotic livers with HCCs within the M-C. Undetectable HCCs in cirrhotic livers may have no impact on recurrence after LT.
源于肝硬化终末期的肝细胞癌（HCC）是肝移植（LT）的合理适应证。为了从病理上研究肝硬化中相对早期阶段 HCC 的多中心发生，我们研究了整个切除的肝脏。
研究了 14 例接受活体供体 LT（LDLT）的患者的 14 个切除肝脏。HCC 的分期被判断为符合米兰标准（M-C；单个 HCC 小于 5 厘米或三个 HCC 小于 3 厘米）。使用 5-7 毫米宽的连续切片标本进行组织学检查。还对术前可检测和不可检测病变进行了特征描述。
在 9 名患者（64.3%）中，在进行全肝组织学检查（WLHE）后总共发现了 34 个结节。在 5 名患者（31%）中，结果超出了 M-C。不可检测 HCC 的特征包括微小（中位大小 6 毫米）、分化良好（80%）、边界模糊（85.3%）且无血管侵犯（94%）。在随访期间（中位随访时间为 30.1 个月），没有任何患者复发。
在符合 M-C 的肝硬化肝脏中证明了 HCC 的多中心发生。肝硬化中不可检测的 HCC 可能对 LT 后复发没有影响。
