Yuki K, Hirohashi S, Sakamoto M, Kanai T, Shimosato Y
Pathology Division, National Cancer Center Research Institute, Tokyo, Japan.
Cancer. 1990 Nov 15;66(10):2174-9. doi: 10.1002/1097-0142(19901115)66:10<2174::aid-cncr2820661022>3.0.co;2-a.
All 240 consecutive cases of hepatocellular carcinoma (HCC) that underwent autopsy at the National Cancer Center Hospital (Tokyo, Japan) between September 1962 and August 1986 were reviewed. Among these cases, 162, for which photographs of cut surfaces of the primary tumors were available, were grossly classified using a combination of both Eggel's classification and our own into three major types, i.e., nodular, massive, and diffuse as described by Eggel (Eggel H, Beitr Pathol Anat 1901; 30:506-604), and three subgroups of nodular type, i.e., single nodular type (type 1), single nodular type with extranodular growth (type 2), and contiguous multinodular type (type 3) by our classification (Kanai T et al., Cancer 1987; 60:810-819). Seventy-eight cases were classified as nodular type, comprising seven cases of type 1, 61 cases of type 2, and ten cases of type 3. Sixty-seven and 17 cases were classified as massive and diffuse type, respectively. Of the 78 nodular-type tumors, 59 measured less than 10 cm, whereas 64 of 67 massive-type tumors were 10 cm or more in size. The incidence of intrahepatic and extrahepatic tumor spread of HCC was significantly higher for tumors measuring more than 5 cm. As to the relationship between macroscopic type and tumor spread, the frequency of spread was lowest for type 1 tumors, and high for the other types. Intrahepatic metastasis was detected in 28.6% of type 1, 93.4% of type 2, 100% of type 3, and 98.5% of massive-type tumors. Lymph node metastasis was detected in 14.3% of type 1, 24.6% of type 2, 70% of type 3, 38.8% of massive-type and 52.9% of diffuse-type tumors. Hematogenous extrahepatic metastasis was detected in 14.3% of type 1, 47.5% of type 2, 70% of type 3, 74.6% of massive-type and 82.4% of diffuse-type tumors. It appears that not only primary tumor size but also its macroscopic type has an important influence on the growth and spread of HCC.
回顾了1962年9月至1986年8月期间在日本东京国立癌症中心医院接受尸检的240例连续肝细胞癌（HCC）病例。在这些病例中，有162例可获得原发肿瘤切面照片，根据埃格耳分类法和我们自己的分类法相结合，将其大体分为三种主要类型，即埃格耳所描述的结节型、巨块型和弥漫型（埃格耳H，《病理学与解剖学文献》1901年；30:506 - 604），以及根据我们的分类法（加纳T等人，《癌症》1987年；60:810 - 819）划分的结节型的三个亚组，即单结节型（1型）、有结节外生长的单结节型（2型）和相邻多结节型（3型）。78例被分类为结节型，包括1型7例、2型61例和3型10例。67例和17例分别被分类为巨块型和弥漫型。在78例结节型肿瘤中，59例直径小于10 cm，而67例巨块型肿瘤中有64例直径为10 cm或更大。直径大于5 cm的HCC肿瘤肝内和肝外肿瘤扩散的发生率显著更高。关于大体类型与肿瘤扩散之间的关系，1型肿瘤的扩散频率最低，其他类型则较高。1型肿瘤中28.6%检测到肝内转移，2型为93.4%，3型为100%，巨块型为98.5%。1型肿瘤中14.3%检测到淋巴结转移，2型为24.6%，3型为70%，巨块型为38.8%，弥漫型为52.9%。1型肿瘤中14.3%检测到血行性肝外转移，2型为47.5%，3型为70%，巨块型为7
