Division of Anatomical Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada.
Histopathology. 2013 Feb;62(3):458-64. doi: 10.1111/his.12032. Epub 2012 Dec 13.
Several cases of focal nodular hyperplasia (FNH) or similar hyperplastic lesions have been reported adjacent to hepatic neoplasms, including hepatocellular carcinoma, epithelioid haemangioendothelioma and hepatoblastoma. We refer to this hyperplastic response as peritumoral hyperplasia (PTH). Here, we report eight cases of PTH adjacent to primary hepatocellular carcinomas (two) and metastatic neuroendocrine tumours (three), gastrointestinal stromal tumour (one) and colon carcinomas (two).
Sections were stained with H&E and trichrome, and for glutamine synthetase, CD34 and cytokeratin 7. PTH was composed of a peritumoral rim of hyperplastic hepatocytes up to 7.0 mm wide, delimited by adjacent hepatocellular atrophy. PTH had altered plate architecture, strong glutamine synthetase expression and variable sinusoidal endothelial cell CD34 expression. The central tumour deposit typically invaded portal veins and was markedly hypervascular with CD34-positive capillaries.
We suggest that PTH is a hyperplastic response to increased blood flow in the peritumoral parenchyma. The increased flow occurs when portal vein invasion by a hypervascular tumour causes arterio-portal shunting. While PTH shares some morphological features with FNH, it lacks the defining nodular architecture, central scar and bile ductules. PTH may be related pathophysiologically to FNH, but should be classified as a separate entity because of its distinct morphology and peritumoral location.
已有数例局灶性结节性增生（FNH）或类似增生性病变紧邻肝肿瘤（包括肝细胞癌、上皮样血管内皮细胞瘤和肝母细胞瘤）被报道。我们将这种增生反应称为肿瘤旁增生（PTH）。在此，我们报告了 8 例 PTH 紧邻原发性肝细胞癌（2 例）和转移性神经内分泌肿瘤（3 例）、胃肠道间质瘤（1 例）和结肠癌（2 例）的病例。
切片用 H&E 和三色染色法以及谷氨酰胺合成酶、CD34 和细胞角蛋白 7 染色。PTH 由肿瘤旁增生的肝细胞组成，最宽可达 7.0mm，由相邻的肝细胞萎缩所界定。PTH 有改变的板层结构，强烈的谷氨酰胺合成酶表达和可变的窦内皮细胞 CD34 表达。中央肿瘤沉积物通常侵犯门静脉，且明显富血管，伴有 CD34 阳性的毛细血管。
我们认为 PTH 是肿瘤旁实质中血流增加的增生反应。当富血管肿瘤侵犯门静脉导致动静脉分流时，就会发生这种增加的血流。虽然 PTH 与 FNH 具有一些形态学特征，但它缺乏定义性的结节状结构、中央瘢痕和胆管。PTH 在病理生理学上可能与 FNH 有关，但由于其独特的形态和肿瘤旁位置，应将其分类为独立实体。
