Department of Pathology, University of California at San Francisco, San Francisco, CA.
Adv Anat Pathol. 2018 Jul;25(4):254-262. doi: 10.1097/PAP.0000000000000189.
The distinction of hepatocellular adenoma from well-differentiated hepatocellular carcinoma (HCC) can be difficult in some cases, especially on biopsy specimens. These borderline cases often occur in men or older patients and may have β-catenin activation or focal atypical morphologic features (such as small cell change, prominent pseudoacinar formation, cytologic atypia, focally thick plates, and/or focal reticulin loss) that are insufficient for an unequivocal diagnosis of HCC. The term "atypical hepatocellular neoplasm" has been advocated for these tumors, but a number of other terms, including "atypical adenoma," "hepatocellular neoplasm of uncertain malignant potential," and "well-differentiated hepatocellular neoplasm with atypical or borderline features" have also been proposed. This review proposes guidelines for designating tumors as atypical hepatocellular neoplasm and describes clinical, morphologic, immunohistochemical, molecular, and cytogenetic features that distinguish these tumors from typical hepatocellular adenoma and HCC.
肝细胞腺瘤与分化良好的肝细胞癌（HCC）的鉴别在某些情况下可能较为困难，尤其是在活检标本上。这些交界性病例常发生于男性或老年患者，可能存在β-catenin 激活或局灶性非典型形态特征（如小细胞改变、显著假腺泡形成、细胞学异型性、局灶性厚板状结构和/或局灶性网状纤维缺失），但不足以明确诊断为 HCC。对于这些肿瘤，曾提出使用“非典型肝细胞性肿瘤”这一术语，但也提出了许多其他术语，包括“非典型腺瘤”、“恶性潜能不确定的肝细胞性肿瘤”和“具有非典型或交界性特征的分化良好的肝细胞性肿瘤”。本综述提出了将肿瘤指定为非典型肝细胞性肿瘤的指南，并描述了这些肿瘤与典型肝细胞腺瘤和 HCC 相鉴别的临床、形态学、免疫组织化学、分子和细胞遗传学特征。
