Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, NY 12208, United States.
Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States.
World J Gastroenterol. 2019 Apr 14;25(14):1653-1665. doi: 10.3748/wjg.v25.i14.1653.
Histopathologic diversity and several distinct histologic subtypes of hepatocellular carcinoma (HCC) are well-recognized. Recent advances in molecular pathology and growing knowledge about the biology associated with distinct histologic features and immuno-profile in HCC allowed pathologists to update classifications. Improving sub-classification will allow for more clinically relevant diagnoses and may allow for stratification into biologically meaningful subgroups. Therefore, immuno-histochemical and molecular testing are not only diagnostically useful, but also are being incorporated as crucial components in predicting prognosis of the patients with HCC. Possibilities of targeted therapy are being explored in HCC, and it will be important for pathologists to provide any data that may be valuable from a theranostic perspective. Herein, we review and provide updates regarding the pathologic sub-classification of HCC. Pathologic diagnostic approach and the role of biomarkers as prognosticators are reviewed. Further, the histopathology of four particular subtypes of HCC: Steatohepatitic, clear cell, fibrolamellar and scirrhous - and their clinical relevance, and the recent consensus on combined HCC-cholangiocarcinoma is summarized. Finally, emerging novel biomarkers and new approaches to HCC stratification are reviewed.
肝细胞癌 (HCC) 的组织病理学多样性和几种不同的组织学亚型是公认的。分子病理学的最新进展以及对与 HCC 的不同组织学特征和免疫特征相关的生物学的深入了解,使病理学家能够更新分类。改善亚分类将允许更具临床相关性的诊断,并可能允许将其分为具有生物学意义的亚组。因此,免疫组织化学和分子检测不仅具有诊断意义,而且还被纳入预测 HCC 患者预后的重要组成部分。在 HCC 中正在探索靶向治疗的可能性,病理学家提供从治疗角度可能有价值的数据将非常重要。在此,我们回顾并提供 HCC 病理亚分类的最新信息。回顾了病理诊断方法和生物标志物作为预后标志物的作用。此外,总结了四种特定 HCC 亚型的组织病理学:脂肪性肝炎、透明细胞、纤维板层和硬癌 - 及其临床相关性,以及 HCC-胆管细胞癌联合的最新共识。最后,综述了新兴的新型生物标志物和 HCC 分层的新方法。
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