103例乙肝相关肝硬化肝移植肝脏中的肝细胞癌及其癌前病变：来自伊朗南部的一项研究

Hepatocellular Carcinoma and Its Precursors in 103 HBV-Related Cirrhotic Explanted Livers: A Study from South Iran.

作者信息

Yazdanpanah Shahrzad, Geramizadeh Bita, Nikeghbalian Saman, Malek-Hosseini Seyed Ali

机构信息

Department of Pathology, Shiraz University of Medical Sciences, Shiraz, IR Iran.

Department of Pathology, Shiraz University of Medical Sciences, Shiraz, IR Iran; Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.

出版信息

Hepat Mon. 2016 Jul 20;16(8):e38584. doi: 10.5812/hepatmon.38584. eCollection 2016 Aug.

DOI:10.5812/hepatmon.38584

PMID:27795725

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5070563/

Abstract

BACKGROUND

The most common cause of liver transplantation in Iran is hepatitis B positive cirrhosis, and it also one of the major and important causes of hepatocellular carcinoma (HCC). Most cases with HCC follow a multistep sequence. Morphologic lesions during hepatocarcinogenesis include dysplastic lesions and small cancerous lesions (2 cm in diameter; early HCC). However, insufficient information is available on the incidence of HCC and its precursors in hepatitis B-related cirrhosis.

OBJECTIVES

In this study, we determined the incidence of HCC and its precursors in hepatitis B-related cirrhosis in the largest liver transplant center in Iran.

METHODS

In a two-year study, all explanted livers of patients with hepatitis B virus (HBV)-positive cirrhosis were completely sectioned and examined. Each specimen was investigated grossly and microscopically to determine any abnormal nodule or cellular changes (at least 15 sections from each liver).

RESULTS

Among all explanted cirrhotic livers (103 livers) during the study period (2014 - 2015), 92 (89.3%) had dysplastic foci with large cell changes (LCC), 57 (55.3%) of which showed small cell changes (SCC) as well. Thirty-nine cases (37.9%) had low-grade dysplastic nodules (LGDN), 38 (36.9%) high-grade dysplastic nodules (HGDN), 19 (18.4%) were early hepatocellular carcinoma (eHCC), and 21 (20.4%) were hepatocellular carcinoma more than 2 cm. All the cases with eHCC and HCC of more than 2 cm also had SCC, LCC, HGDN, and LGDN. Thirteen cases of eHCC were accompanied with HCCs more than 2 cm, and 6 cases of eHCC did not show any HCC (larger than 2 cm).

CONCLUSIONS

SCC, LGDN, and HGDN are common associated findings and precursors of HCC in livers infected with hepatitis B. A strict follow-up and a precise and thorough sampling of livers with SCC and any abnormal dysplastic nodules (DNs), especially those larger than 1 cm, are highly recommended because these DNs are highly associated with malignancy.

摘要

背景

在伊朗，肝移植最常见的原因是乙肝阳性肝硬化，它也是肝细胞癌（HCC）的主要且重要病因之一。大多数HCC病例遵循多步骤进程。肝癌发生过程中的形态学病变包括发育异常病变和小癌性病变（直径2厘米；早期HCC）。然而，关于乙肝相关肝硬化中HCC及其癌前病变的发病率，现有信息不足。

目的

在本研究中，我们在伊朗最大的肝移植中心确定了乙肝相关肝硬化中HCC及其癌前病变的发病率。

方法

在一项为期两年的研究中，对所有乙肝病毒（HBV）阳性肝硬化患者的切除肝脏进行完整切片并检查。对每个标本进行大体和显微镜检查，以确定是否存在任何异常结节或细胞变化（每个肝脏至少15个切片）。

结果

在研究期间（2014 - 2015年）的所有切除肝硬化肝脏（103个肝脏）中，92个（89.3%）有大细胞改变（LCC）的发育异常灶，其中57个（55.3%）也有小细胞改变（SCC）。39例（37.9%）有低级别发育异常结节（LGDN），38例（36.9%）有高级别发育异常结节（HGDN），19例（18.4%）为早期肝细胞癌（eHCC），21例（20.4%）为直径超过2厘米的肝细胞癌。所有eHCC和直径超过2厘米的HCC病例也都有SCC、LCC、HGDN和LGDN。13例eHCC伴有直径超过2厘米的HCC，6例eHCC未显示任何HCC（直径大于2厘米）。