Department of Pathology, Columbia University Medical Center, New York, NY 10032, USA.
Am J Surg Pathol. 2010 Nov;34(11):1630-6. doi: 10.1097/PAS.0b013e3181f31caa.
In explant livers with chronic hepatitis C (HCV-C) we have noted a distinctive histologic variant that we have termed steatohepatitic hepatocellular carcinoma (SH-HCC) with features resembling non-neoplastic steatohepatitis, including large droplet steatosis, ballooning of malignant hepatocytes, Mallory-Denk bodies, inflammation, and pericellular fibrosis. This study was undertaken to further describe the characteristics and prevalence of this histologic variant in HCV-C and any possible association with underlying risk factors for nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). We selected two 2-year periods (mid-2003 to mid-2005 and 2007 to 2008), from which selected explant livers with HCV-C and HCC were examined to determine the characteristics and frequency of SH-HCC. The underlying cirrhotic liver was also reassessed for steatosis and evidence of steatohepatitis. Clinical records were consulted for concomitant NAFLD and NASH risk factors. The SH-HCC variant was found in a total of 22 of 62 HCC cases (35.5%). Fourteen of the 22 patients with SH-HCC (63.6%) had at least one known risk factor for NAFLD/NASH including diabetes (6 of 22, 27.3%), obesity (6 of 22, 27.3%), hypertension (11 of 22, 50%), and hyperlipidemia (5 of 22, 27.8%). In 14 of the 22 cases (63.6%) of SH-HCC, the non-neoplastic liver showed changes of NAFLD/NASH superimposed on otherwise typical features of HCV-C. In conclusion, in our series of HCV-C explants, approximately one-third of HCCs show a distinctive histological variant termed SH-HCC. Underlying risk factors for NAFLD and for NASH were identified in 63.6% of our cases. Moreover, non-neoplastic tissue in HCV-C explants showed changes of NAFLD/NASH in 63.6% of cases. These results suggest a possible NAFLD/NASH pathway leading to SH-HCC in the setting of HCV-C which requires further investigation in the future.
在患有慢性丙型肝炎 (HCV-C) 的肝移植标本中，我们观察到一种独特的组织学变异型，我们将其命名为伴有类似非肿瘤性脂肪性肝炎特征的脂肪性肝炎性肝细胞癌 (SH-HCC)，包括大液滴脂肪变性、恶性肝细胞气球样变、Mallory-Denk 小体、炎症和细胞周纤维化。这项研究旨在进一步描述 HCV-C 中这种组织学变异型的特征和流行率，以及其与非酒精性脂肪性肝病 (NAFLD) 和非酒精性脂肪性肝炎 (NASH) 潜在危险因素的任何可能关联。我们选择了两个 2 年的时间段（2003 年年中至 2005 年年中以及 2007 年至 2008 年），在此期间，检查了患有 HCV-C 和 HCC 的选定肝移植标本，以确定 SH-HCC 的特征和频率。还重新评估了基础肝硬化肝的脂肪变性和脂肪性肝炎的证据。查阅了临床记录，以了解同时存在的 NAFLD 和 NASH 危险因素。在总共 62 例 HCC 病例中，有 22 例（35.5%）发现了 SH-HCC 变异型。22 例 SH-HCC 患者中有 14 例（63.6%）至少有一种已知的 NAFLD/NASH 危险因素，包括糖尿病（22 例中的 6 例，27.3%）、肥胖（22 例中的 6 例，27.3%）、高血压（22 例中的 11 例，50%）和高脂血症（22 例中的 5 例，27.8%）。在 22 例 SH-HCC 病例中的 14 例（63.6%）中，非肿瘤性肝脏显示出 NAFLD/NASH 的变化，这些变化叠加在 HCV-C 的其他典型特征上。总之，在我们的 HCV-C 肝移植标本系列中，大约三分之一的 HCC 显示出一种独特的组织学变异型，称为 SH-HCC。我们的病例中有 63.6% 确定了 NAFLD 和 NASH 的潜在危险因素。此外，HCV-C 肝移植标本中非肿瘤性组织在 63.6%的病例中显示出 NAFLD/NASH 的变化。这些结果表明，在 HCV-C 背景下，NAFLD/NASH 途径可能导致 SH-HCC，这需要在未来进一步研究。
