Kumar Deepika, Hafez Omeed, Jain Dhanpat, Zhang Xuchen
Department of Pathology, Yale School of Medicine, New Haven, CT, 06520, United States.
Department of Pathology, Yale School of Medicine, New Haven, CT, 06520, United States.
Hum Pathol. 2021 Jul;113:39-46. doi: 10.1016/j.humpath.2021.04.008. Epub 2021 Apr 24.
Studies comparing the histomorphologic features and phenotypic heterogeneity between primary and its corresponding metastatic hepatocellular carcinoma (HCC) are lacking. The aim of this study was to assess and compare the histomorphologic features and heterogeneity between primary and metastatic HCC. A total of 39 cases with both primary and metastatic tissues were identified from pathology archives (2000-2019). The common sites of metastasis included lung (28.21%), abdominal cavity (25.64%), lymph nodes (20.51%), bone (17.95%), soft tissue (15.38%), and adrenal gland (10.26%). Both the primary and metastatic tumors showed heterogeneity in intratumoral histologic patterns (87.18% and 76.92%, respectively). The most common histologic pattern was solid in both primary (61.54%) and metastases (56.41%), followed by macrotrabecular in primary (17.95%) and metastases (10.26%). Among HCC-subtypes, macrotrabecular-massive HCC was the most common subtype in both primary and metastases (28.21% each). Primary tumors in noncirrhotic livers were more likely to have larger size and microvascular invasion than those in cirrhotic livers. The histomorphology (histologic pattern, subtype, and grade) between the primary and metastases was discordant in about 50% cases (48.72%, 48.72%, and 51.28%, respectively). Our findings exhibit significant intratumoral heterogeneity and histomorphologic discordance between primary and metastatic HCCs. The solid and macrotrabecular histologic patterns and the macrotrabecular-massive subtype were the most common histomorphologic features seen in primary tumors associated with metastasis. Further studies to identify and explore different pathways that promote HCC metastasis and to compare the differences between primary and metastatic tumors on a larger cohort are needed to better understand the pathogenesis of metastasis.
目前尚缺乏对原发性及其相应转移性肝细胞癌（HCC）之间组织形态学特征和表型异质性进行比较的研究。本研究的目的是评估和比较原发性和转移性HCC的组织形态学特征及异质性。从病理档案（2000 - 2019年）中总共鉴定出39例同时具有原发性和转移性组织的病例。常见转移部位包括肺（28.21%）、腹腔（25.64%）、淋巴结（20.51%）、骨（17.95%）、软组织（15.38%）和肾上腺（10.26%）。原发性和转移性肿瘤在瘤内组织学模式上均表现出异质性（分别为87.18%和76.92%）。最常见的组织学模式在原发性肿瘤（61.54%）和转移瘤（56.41%）中均为实性，其次在原发性肿瘤中为大梁状（17.95%），在转移瘤中为大梁状（10.26%）。在HCC亚型中，大梁状 - 巨块型HCC在原发性和转移瘤中均为最常见的亚型（各占28.21%）。非肝硬化肝脏中的原发性肿瘤比肝硬化肝脏中的原发性肿瘤更有可能具有更大的尺寸和微血管侵犯。原发性和转移瘤之间的组织形态学（组织学模式、亚型和分级）在约50%的病例中不一致（分别为48.72%、48.72%和51.28%）。我们的研究结果显示原发性和转移性HCC之间存在显著的瘤内异质性和组织形态学不一致性。实性和大梁状组织学模式以及大梁状 - 巨块型亚型是与转移相关的原发性肿瘤中最常见的组织形态学特征。需要进一步开展研究以识别和探索促进HCC转移的不同途径，并在更大队列中比较原发性和转移性肿瘤之间的差异，以便更好地理解转移的发病机制。
