Jiang Kun, Al-Diffhala Sameer, Centeno Barbara A
1 Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
2 Department of Oncologic Sciences, Morsani College of Medicine at University of South Florida, Tampa, FL, USA.
Cancer Control. 2018 Jan-Mar;25(1):1073274817744625. doi: 10.1177/1073274817744625.
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) are the 2 most common primary malignant liver tumors, with hepatocellular and bile ductular differentiation, respectively. This article reviews the key histopathological findings of these 2 primary liver cancers and includes a review of the role of ancillary testing for differential diagnosis, risk stratification according to the American Joint Committee on Cancer (AJCC) staging recommendation, and a review of precancerous lesions. A literature review was conducted to identify articles with information relevant to precancerous precursors, current histopathological classification, ancillary testing, and risk stratification of primary malignant liver tumors. The histomorphology of normal liver, preinvasive precursors, primary malignancies, and morphological variants, and the utilization of ancillary tests for the pathological diagnosis are described. Dysplastic nodules are the preinvasive precursors of HCC, and intraductal papillary neoplasms of bile ducts and biliary intraepithelial neoplasia are the preinvasive precursors of CC. Benign liver nodules including focal nodular hyperplasia and adenomas are included in this review, since some forms of adenomas progress to HCC and often they have to be differentiated from well-differentiated HCC. A number of morphological variants of HCC have been described in the literature, and it is necessary to be aware of them in order to render the correct diagnosis. Risk stratification is still dependent on the AJCC staging system. The diagnosis of primary liver carcinomas is usually straightforward. Application of the appropriate ancillary studies aids in the differential diagnosis of difficult cases. The understanding of the carcinogenesis of these malignancies has improved with the standardization of the pathological classification of preinvasive precursors and studies of the molecular pathogenesis. Risk stratification still depends on pathological staging.
肝细胞癌（HCC）和胆管癌（CC）是两种最常见的原发性恶性肝肿瘤，分别具有肝细胞和胆管上皮分化。本文回顾了这两种原发性肝癌的关键组织病理学发现，包括辅助检测在鉴别诊断中的作用、根据美国癌症联合委员会（AJCC）分期建议进行风险分层，以及对癌前病变的回顾。进行了文献综述，以确定与原发性恶性肝肿瘤的癌前病变、当前组织病理学分类、辅助检测和风险分层相关信息的文章。描述了正常肝脏、浸润前病变、原发性恶性肿瘤和形态学变异的组织形态学，以及辅助检测在病理诊断中的应用。发育异常结节是HCC的浸润前病变，胆管内乳头状肿瘤和胆管上皮内瘤变是CC的浸润前病变。本综述包括良性肝结节，如局灶性结节性增生和腺瘤，因为某些形式的腺瘤会进展为HCC，并且它们常常需要与高分化HCC进行鉴别。文献中描述了许多HCC的形态学变异，为了做出正确诊断，有必要了解它们。风险分层仍然依赖于AJCC分期系统。原发性肝癌的诊断通常很直接。应用适当的辅助检查有助于疑难病例的鉴别诊断。随着浸润前病变病理分类的标准化和分子发病机制的研究，对这些恶性肿瘤发生机制的理解有了提高。风险分层仍然依赖于病理分期。
