Department of Pathology, The Department of Veteran Affairs New York Harbor Healthcare System, Brooklyn.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto.
Am J Surg Pathol. 2020 Oct;44(10):1406-1412. doi: 10.1097/PAS.0000000000001533.
Steatohepatitic hepatocellular carcinoma (SH-HCC) is a variant of hepatocellular carcinoma (HCC) with established association with nonalcoholic steatohepatitis (NASH), while its association with alcoholic steatohepatitis (ASH) is unclear. We studied 2 cohorts of patients who underwent resection for HCC in the setting of steatohepatitis. In our Mount Sinai (New York) cohort, we found SH-HCC in 17/24 (71%) patients with NASH and in 14/19 (74%) patients with ASH, while SH-HCC was the predominant tumor morphology in 12/24 (50%) in the NASH group and 9/19 (47%) in the ASH group. Upon review, 12/19 patients diagnosed with ASH also had diabetes and/or a body mass index >30. When these patients were removed, we still found similar rates of SH-HCC (6/7 [86%] showed SH-HCC, while SH-HCC was predominant in 3/7 [43%]. Interestingly, glycogenated hepatocyte nuclei were seen in the nontumor liver in 4/7 (57%) of these cases. In our Japan cohort, we also found similar rates of SH-HCC in NASH and ASH patients with HCC, 15/58 (26%), and 16/45 (36%), respectively. We determined molecular subclassification of tumors from the Japan cohort and found no difference in the distribution of S1, S2 and S3 subclasses among the ASH and NASH groups, though, among cases of SH-HCC, there was a trend toward an association of ASH with S1 (P=0.054) and NASH with S3 (P=0.052). Our study shows that SH-HCC is common in both ASH and NASH and that both underlying liver diseases produce tumors with similar molecular profiles, though different pathways may underlie the development of SH-HCC in ASH versus NASH.
脂肪性肝炎相关性肝细胞癌（SH-HCC）是一种与非酒精性脂肪性肝炎（NASH）明确相关的肝细胞癌（HCC）变异型，而其与酒精性脂肪性肝炎（ASH）的相关性尚不清楚。我们研究了两组在脂肪性肝炎背景下接受 HCC 切除术的患者。在我们的西奈山（纽约）队列中，我们发现 17/24（71%）例 NASH 患者和 14/19（74%）例 ASH 患者存在 SH-HCC，而在 NASH 组中，12/24（50%）例患者的主要肿瘤形态为 SH-HCC，ASH 组中 9/19（47%）例患者的主要肿瘤形态为 SH-HCC。经审查，19 例被诊断为 ASH 的患者中有 12 例还患有糖尿病和/或体重指数>30。当去除这些患者后，我们仍然发现 SH-HCC 的发生率相似（6/7[86%]例显示为 SH-HCC，而 3/7[43%]例患者的主要肿瘤形态为 SH-HCC）。有趣的是，在这些病例中的 4/7（57%）例非肿瘤肝脏中可见糖原化肝细胞核。在我们的日本队列中，我们还发现 NASH 和 ASH 患者的 HCC 中 SH-HCC 的发生率相似，分别为 15/58（26%）和 16/45（36%）。我们从日本队列中确定了肿瘤的分子分类，发现 ASH 和 NASH 组中 S1、S2 和 S3 亚类的分布没有差异，尽管在 SH-HCC 病例中，ASH 与 S1 （P=0.054）和 NASH 与 S3（P=0.052）之间存在关联的趋势。我们的研究表明，SH-HCC 在 ASH 和 NASH 中都很常见，两种潜在的肝病都会产生具有相似分子特征的肿瘤，尽管 ASH 与 NASH 中 SH-HCC 的发展可能涉及不同的途径。
