Department of Pathology, University of Milan School of Medicine & Humanitas Clinical Institute, Rozzano, Milan, Italy.
Dig Liver Dis. 2011 Mar;43 Suppl 4:S361-72. doi: 10.1016/S1590-8658(11)60592-6.
The current ability to increase the survival of patients with hepatocellular carcinoma (HCC) relies upon the surveillance of cirrhotic patients. Surveillance allows HCC precursors (dysplastic nodules) and malignant tumors to be recognized at an earlier stage making cure possible. Radiology plays a major role in HCC diagnosis because HCC is characterized by neoarterial vascularisation with a typical imaging pattern. Current international guidelines have restricted the use of the liver biopsy to the characterization of hepatocellular nodules which remain diagnostically equivocal after imaging. Thus pathologists are today facing very challenging and often well differentiated lesions, leading to difficulties in distinguishing high grade dysplasia and well differentiated HCC. In this scenario novel concepts obtained through international consensus have been proposed with emphasis on HCC of small size (up to 2 cm) which includes 2 distinct types, the early and progressed HCC. In this paper we will report the main histopathological criteria of a biopsy which allow the differentiation of HCC precursors (dysplastic nodules) from well differentiated HCC with attention to the role and weight of both classical histopathological criteria and novel immunocytochemical markers. The second part of the paper is devoted to the histopathology report of HCC on surgical specimens including explanted livers and on the differential diagnosis between HCC and liver metastasis.
目前，提高肝细胞癌（HCC）患者生存率的能力依赖于对肝硬化患者的监测。监测可以更早地发现 HCC 前体（异型结节）和恶性肿瘤，从而实现治愈。放射学在 HCC 诊断中起着重要作用，因为 HCC 的特征是新生动脉血管化，具有典型的影像学模式。目前的国际指南将肝活检的应用仅限于对影像学表现仍存在诊断疑问的肝细胞结节进行特征描述。因此，病理学家现在面临着非常具有挑战性的、通常是分化良好的病变，导致难以区分高级别异型增生和分化良好的 HCC。在这种情况下，通过国际共识获得了新的概念，强调了直径不超过 2 厘米的小 HCC，包括两种不同类型：早期 HCC 和进展期 HCC。在本文中，我们将报告活检的主要组织病理学标准，以区分异型结节和分化良好的 HCC，同时关注经典组织病理学标准和新型免疫细胞化学标志物的作用和权重。本文的第二部分专门介绍了手术标本（包括移植肝脏）中 HCC 的组织病理学报告，以及 HCC 与肝转移之间的鉴别诊断。
