Department of Human Pathology, Kanazawa University Hospital, Kanazawa, Japan.
Mod Pathol. 2012 Dec;25(12):1584-93. doi: 10.1038/modpathol.2012.114. Epub 2012 Jul 6.
Hepatocellular adenoma usually arises in the absence of significant fibrosis. Herein, we report seven patients with serum amyloid A-positive hepatocellular neoplasm, which shares features with inflammatory hepatocellular adenoma arising in alcoholic cirrhosis. Seven patients (two women and five men, age range 41-67 years) with hypervascular hepatocellular nodules associated with alcoholic cirrhosis were retrieved from our pathological files (1997-2011). The hepatocellular nodules were multiple (>3) in all patients and 17 nodules were histologically examined. We surveyed the immunoreactivity for serum amyloid A, glutamine synthetase, and glypican-3 in the hepatocellular nodules and control lesions, including 5 focal nodular hyperplasia, 18 dysplastic nodules, and 54 hepatocellular carcinomas in various background diseases. In all, 15 of 17 nodules showed strong and distinct immunoreactivity for serum amyloid A, sharing features with inflammatory hepatocellular adenoma. The serum amyloid A-positive hepatocellular neoplasms showed increased cellular density, inflammatory infiltrate, sinusoidal dilatation, and ductular reaction to various degrees. Although about a half of dysplastic nodules and hepatocellular carcinomas showed focal immunoreactivity for serum amyloid A, the extent of serum amyloid A expression was significantly higher in serum amyloid A-positive hepatocellular neoplasms, than in control nodules. The serum amyloid A-positive hepatocellular neoplasms did not show the overexpression of glutamine synthetase or immunoreactivity for glypican-3. In contrast, most hepatocellular carcinomas showed the overexpression of glutamine synthetase and immunoreactivity for glypican-3, irrespective of background diseases. In conclusion, this study highlights a characteristic group of hepatocellular neoplasms arising in alcoholic cirrhosis, which share features with inflammatory hepatocellular adenomas. These serum amyloid A-positive hepatocellular neoplasms may be a new type of inflammatory hepatocellular tumors in alcoholic patients.
肝细胞腺瘤通常在无明显纤维化的情况下发生。在此，我们报告了 7 例血清淀粉样蛋白 A 阳性的肝细胞肿瘤患者，这些患者具有酒精性肝硬化中发生的炎症性肝细胞腺瘤的特征。从我们的病理档案中（1997-2011 年）检索到 7 例伴有酒精性肝硬化的富血管性肝细胞结节患者（2 名女性和 5 名男性，年龄 41-67 岁）。所有患者的肝细胞结节均为多发性（>3），并对 17 个结节进行了组织学检查。我们调查了血清淀粉样蛋白 A、谷氨酰胺合成酶和 Glypican-3 在肝细胞结节和对照病变中的免疫反应性，包括 5 个局灶性结节性增生、18 个异型增生结节和 54 个各种背景疾病的肝细胞癌。总的来说，17 个结节中有 15 个显示出强烈而明显的血清淀粉样蛋白 A 免疫反应性，与炎症性肝细胞腺瘤具有相同的特征。血清淀粉样蛋白 A 阳性的肝细胞肿瘤表现出不同程度的细胞密度增加、炎症浸润、窦扩张和胆管反应。虽然大约一半的异型增生结节和肝细胞癌表现出局灶性的血清淀粉样蛋白 A 免疫反应性，但血清淀粉样蛋白 A 阳性的肝细胞肿瘤中血清淀粉样蛋白 A 的表达程度明显高于对照结节。血清淀粉样蛋白 A 阳性的肝细胞肿瘤没有表现出谷氨酰胺合成酶的过度表达或 Glypican-3 的免疫反应性。相反，大多数肝细胞癌表现出谷氨酰胺合成酶的过度表达和 Glypican-3 的免疫反应性，而与背景疾病无关。总之，本研究强调了一组在酒精性肝硬化中发生的具有特征性的肝细胞肿瘤，这些肿瘤与炎症性肝细胞腺瘤具有相同的特征。这些血清淀粉样蛋白 A 阳性的肝细胞肿瘤可能是酒精性患者中一种新型的炎症性肝细胞肿瘤。
