Pehlivanoglu Burcin, Aysal Anil, Agalar Cihan, Egeli Tufan, Ozbilgin Mucahit, Unek Tarkan, Unek Tugba, Oztop Ilhan, Sagol Ozgul
Department of Molecular Pathology, Graduate School of Health Sciences, Dokuz Eylul University, Izmir, Turkey.
Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
APMIS. 2022 Jun;130(6):346-356. doi: 10.1111/apm.13220. Epub 2022 Apr 18.
Data on peritumoral histopathologic findings in patients with hepatocellular carcinoma (HCC) is limited. In this retrospective study, we evaluated the peritumoral histopathologic changes in patients with chronic viral hepatitis (CVH)-associated HCC (CVH-HCC) and their prognostic value. 61 consecutive cirrhotic patients who underwent liver transplantation due to CVH-HCC were included. Histopathologic features within 1 cm distance of the tumor, and their association with clinicopathological characteristics and prognosis were evaluated. A random representative slide of cirrhotic parenchyma unrelated to invasive and/or dysplastic foci was also evaluated for the same histopathologic criteria. The majority (85%, n = 52) were male with a median age of 55 ± 6.38 (range, 39-67). The etiologic agent was only HBV in 90% (n = 55). The most common peritumoral findings were portal inflammation (100%; n = 61), ductular reaction (100%; n = 61) and sinusoidal dilatation (95%; n = 58). Macrovascular invasion was observed only in four cases (7%) with mild peritumoral portal inflammation. Neutrophilic infiltration of the peritumoral portal tracts (n = 18; 30%) was significantly associated with pT4 tumor stage, tumor grade, macrovascular invasion, and pretransplant therapy. Patients with moderate or severe peritumoral sinusoidal dilatation tended to have worse prognosis, albeit not significantly. Peritumoral ballooning degeneration was associated with multifocality, recurrence and recurrence-free survival in both uni- and multivariate analysis. Peritumoral histopathologic changes in CVH-HCC can be classified as: changes related to pathogenesis, changes indirectly affecting prognosis, and changes directly affecting prognosis. Peritumoral prominent ballooning degeneration may be a predictor of recurrence while portal neutrophilic infiltration and sinusoidal dilatation seem to indicate poor prognosis.
肝细胞癌（HCC）患者瘤周组织病理学发现的数据有限。在这项回顾性研究中，我们评估了慢性病毒性肝炎（CVH）相关肝细胞癌（CVH-HCC）患者的瘤周组织病理学变化及其预后价值。纳入了61例因CVH-HCC接受肝移植的连续性肝硬化患者。评估肿瘤周围1厘米范围内的组织病理学特征，以及它们与临床病理特征和预后的相关性。还针对相同的组织病理学标准评估了与侵袭性和/或发育异常灶无关的肝硬化实质的随机代表性切片。大多数患者（85%，n = 52）为男性，中位年龄为55±6.38岁（范围39 - 67岁）。90%（n = 55）的病因仅为乙肝病毒。最常见的瘤周表现为门管区炎症（100%；n = 61）、小胆管反应（100%；n = 61）和肝血窦扩张（95%；n = 58）。仅在4例（7%）伴有轻度瘤周门管区炎症的病例中观察到微血管侵犯。瘤周门管区的中性粒细胞浸润（n = 18；30%）与pT4肿瘤分期、肿瘤分级、微血管侵犯和移植前治疗显著相关。瘤周肝血窦中度或重度扩张的患者预后往往较差，尽管差异无统计学意义。瘤周气球样变在单因素和多因素分析中均与多灶性、复发及无复发生存相关。CVH-HCC的瘤周组织病理学变化可分为：与发病机制相关的变化、间接影响预后的变化和直接影响预后的变化。瘤周显著气球样变可能是复发的预测指标，而门管区中性粒细胞浸润和肝血窦扩张似乎提示预后不良。
