Nakanuma Y, Terada T, Terasaki S, Ueda K, Nonomura A, Kawahara E, Matsui O
Department of Pathology, Kanazawa University School of Medicine, Japan.
Histopathology. 1990 Jul;17(1):27-35. doi: 10.1111/j.1365-2559.1990.tb00660.x.
Adenomatous hyperplasia, defined as a sizable parenchymal nodule in cirrhosis, was examined morphologically. Ninety-seven nodules of adenomatous hyperplasia were obtained from 47 cirrhotic livers and were divided into 'ordinary' (44 nodules) and 'atypical' (53 nodules) types. The former consisted of hepatocytes similar to those of the surrounding liver, and showed regularly distributed portal tracts. The latter type was composed of hepatocytes showing nuclear atypia, relative to the surrounding liver, and showed irregular or sparse portal tracts. Atypical nodules were histologically heterogeneous, possessing areas of normo-trabecular, compact, pseudoglandular and/or scirrhous patterns. Several cytological changes, such as clear cell change, small or large cell change and fatty change, were intermingled variably within a given nodule. Atypical nodules showed expansive and/or replacing growth into the surrounding liver. Atypical hepatocytes also infiltrated into the fibrous septa and portal tracts. Foci of overt hepatocellular carcinoma were found in 11 of the 53 atypical nodules. These findings suggest that ordinary adenomatous hyperplasia may be a large-sized regenerative nodule, while atypical adenomatous hyperplasia may be a hepatocellular neoplasm, a peculiar form of low-grade hepatocellular carcinoma or borderline lesion, in which overt hepatocellular carcinoma is likely to evolve through multiple steps.
对定义为肝硬化中较大实质结节的腺瘤样增生进行了形态学检查。从47例肝硬化肝脏中获取了97个腺瘤样增生结节，并分为“普通型”（44个结节）和“非典型型”（53个结节）。前者由与周围肝脏相似的肝细胞组成，门管区分布规则。后者由相对于周围肝脏表现出核异型性的肝细胞组成，门管区不规则或稀疏。非典型结节在组织学上具有异质性，具有正常小梁、致密、假腺泡和/或硬化模式的区域。几种细胞学变化，如透明细胞变化、小细胞或大细胞变化以及脂肪变化，在单个结节内以不同方式混合存在。非典型结节表现为向周围肝脏的膨胀性和/或替代性生长。非典型肝细胞也浸润到纤维间隔和门管区。在53个非典型结节中的11个中发现了明显的肝细胞癌灶。这些发现表明，普通腺瘤样增生可能是一个较大的再生结节，而非典型腺瘤样增生可能是一种肝细胞肿瘤，是低级别肝细胞癌的一种特殊形式或临界病变，其中明显的肝细胞癌可能通过多个步骤演变而来。
