Department of Human Pathology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
Histopathology. 2015 May;66(6):836-45. doi: 10.1111/his.12588. Epub 2015 Jan 22.
To characterize serum amyloid A (SAA)-positive hepatocellular neoplasms/nodules arising in alcoholic cirrhosis, which are detected as hypervascular hepatocellular nodules resembling hepatocellular carcinoma on imaging.
Fifty-three hepatocellular nodules were examined with immunostaining for SAA, glutamine synthetase and glypican-3 in 23 patients (four women and 19 men) with alcoholic cirrhosis. Sixteen nodules were examined with magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid enhancement (EOB-MRI). Somatic mutations in IL6ST, GNAS and STAT3 were examined in 19 nodules. Thirty-six nodules in 18 patients were diagnosed as SAA-positive hepatocellular neoplasms/nodules, and the remaining 17 nodules in eight patients were SAA-negative focal nodular hyperplasia (FNH)-like nodules. SAA-positive hepatocellular neoplasms/nodules showed significantly more extensive sinusoidal dilatation, inflammatory reaction, abnormally thick arteries and cellular atypia than FNH-like nodules (P < 0.05). Eight SAA-positive hepatocellular neoplasms/nodules (67%) showed slight hypointensity in the hepatobiliary phase on EOB-MRI, whereas all four FNH-like nodules showed iso-intensity (P < 0.05). STAT3 mutations were detected in two of 17 SAA-positive hepatocellular neoplasms/nodules.
This study showed that approximately two-thirds of hypervascular hepatocellular nodules arising in alcoholic cirrhosis were SAA-positive hepatocellular neoplasms/nodules, which show different findings on the EOB-MRI. STAT3 mutations were detected in 11.8% of SAA-positive hepatocellular neoplasms/nodules, supporting a neoplastic nature.
描述在酒精性肝硬化中出现的血清淀粉样蛋白 A（SAA）阳性肝细胞肿瘤/结节，这些肿瘤/结节在影像学上表现为类似于肝细胞癌的富血管性肝细胞结节。
在 23 例酒精性肝硬化患者（4 名女性和 19 名男性）的 53 个肝细胞结节中，通过免疫组织化学染色检测 SAA、谷氨酰胺合成酶和聚糖蛋白-3。在 16 个结节中进行了钆乙氧基苯甲基二乙撑三胺五乙酸增强磁共振成像（EOB-MRI）检查。在 19 个结节中检测了 IL6ST、GNAS 和 STAT3 的体细胞突变。在 18 例患者的 36 个结节中诊断为 SAA 阳性肝细胞肿瘤/结节，在 8 例患者的 17 个剩余结节中诊断为 SAA 阴性局灶性结节性增生（FNH）样结节。SAA 阳性肝细胞肿瘤/结节的窦状扩张、炎症反应、异常增厚的动脉和细胞异型性明显多于 FNH 样结节（P < 0.05）。在 EOB-MRI 的肝胆期，8 个 SAA 阳性肝细胞肿瘤/结节中有 67%（5 个）表现为轻微低信号，而 4 个 FNH 样结节均表现为等信号（P < 0.05）。在 17 个 SAA 阳性肝细胞肿瘤/结节中有 2 个检测到 STAT3 突变。
本研究表明，在酒精性肝硬化中出现的大约三分之二的富血管性肝细胞结节为 SAA 阳性肝细胞肿瘤/结节，其在 EOB-MRI 上具有不同的表现。在 11.8%的 SAA 阳性肝细胞肿瘤/结节中检测到 STAT3 突变，支持其具有肿瘤性质。
