脂肪性肝病与肝细胞癌：病理医师的视角。

Fatty Liver Disease and Hepatocellular Carcinoma: The Pathologist's View.

机构信息

Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.

Department of Pathology, Aretaieion Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.

出版信息

Adv Exp Med Biol. 2018;1032:55-69. doi: 10.1007/978-3-319-98788-0_4.

DOI:10.1007/978-3-319-98788-0_4

PMID:30362090

Abstract

Chronic alcohol misuse and progressed nonalcoholic fatty liver disease (NAFLD) due to the metabolic syndrome and resulting to nonalcoholic steatohepatitis (NASH) are prime causes of hepatocellular carcinoma (HCC) in Western industrialized countries. The incidence of HCC in NASH-cirrhosis is lower than that of HCC occuring in HCV-related or alcoholic cirrhosis. Up to 20% of cases of alcohol-associated HCC may develop in pre-cirrhotic liver while HCC is also increasingly recognised in pre-cirrhotic NASH raising questions on appropriate surveillance measures for these patient populations. The recently described steatohepatitic subtype of HCC presents with higher frequency in NAFLD compared to alcoholic liver disease (ALD) patients. This review will mainly focus on histopathology and summarize current data on the epidemiology, pathogenesis, diagnosis and management of NAFLD- and ALD-related HCC.

摘要

慢性酒精滥用和由于代谢综合征导致的进展性非酒精性脂肪性肝病（NAFLD），进而发展为非酒精性脂肪性肝炎（NASH），是西方国家肝细胞癌（HCC）的主要病因。在 NASH 相关肝硬化中，HCC 的发病率低于丙型肝炎病毒（HCV）相关或酒精性肝硬化。高达 20%的酒精相关性 HCC 可能发生在肝硬化前肝脏，而 HCC 也越来越多地在肝硬化前 NASH 中被发现，这对这些患者人群的适当监测措施提出了疑问。最近描述的脂肪性肝炎型 HCC 在非酒精性脂肪性肝病（NAFLD）患者中比酒精性肝病（ALD）患者更为常见。这篇综述将主要侧重于组织病理学，并总结目前关于 NAFLD 和 ALD 相关 HCC 的流行病学、发病机制、诊断和管理的相关数据。