Lefkowitch J H
Surg Clin North Am. 1981 Feb;61(1):169-80. doi: 10.1016/s0039-6109(16)42341-8.
The ubiquitous problem of cirrhosis may be complicated by the development of primary liver cell carcinoma, with rates of incidence so high in certain parts of the world as to make it a candidate for the most common cancer in humans. When cirrhosis reaches the macronodular stage, the risk of developing liver cell carcinoma increases, and at this point liver cell dysplasia may be seen in biopsy. Alcoholics, who classically have a micronodular cirrhosis, may attain the macronodular pattern through better clinical management, abstinence, and longer survival. Hepatitis B-related cirrhosis, on the other hand, is most often macronodular. Recent DNA hybridization studies strongly favor a viral role in oncogenesis, and this possibility is supported by the serologic and epidemiologic evidence complied in the last decade. Liver cell malignant tumors tend to recapitulate the characteristics of normal liver, namely, growth in cords, uniformity of cytologic appearances, and bile production, but also present distinctive histologic and immunohistochemical patterns that are unique to a malignant liver cell population. The other primary malignant tumors of the liver, arising in bile ducts, blood vessels, and mesenchymal elements, all carry their individual epidemiology and morphology, but in general invoke, as does liver cell carcinoma, the concept of a series of step by step cell-carcinogen and cell-carcinogen interactions by which normal cells give rise to malignant populations.
肝硬化这一普遍存在的问题可能会因原发性肝细胞癌的发生而复杂化，在世界某些地区其发病率极高，以至于成为人类最常见癌症的候选病种。当肝硬化发展到巨结节阶段时，发生肝细胞癌的风险会增加，此时活检中可见肝细胞发育异常。典型的患有小结节性肝硬化的酗酒者，通过更好的临床管理、戒酒和更长的生存期，可能会转变为巨结节模式。另一方面，乙型肝炎相关的肝硬化大多是巨结节性的。最近的DNA杂交研究强烈支持病毒在肿瘤发生中的作用，过去十年积累的血清学和流行病学证据也支持了这一可能性。肝细胞恶性肿瘤往往重现正常肝脏的特征，即呈索状生长、细胞外观均匀一致以及产生胆汁，但也呈现出恶性肝细胞群体特有的独特组织学和免疫组化模式。肝脏的其他原发性恶性肿瘤，起源于胆管、血管和间叶成分，都有其各自的流行病学和形态学特点，但总体而言，与肝细胞癌一样，都涉及一系列正常细胞通过逐步的细胞-致癌物和细胞-致癌物相互作用产生恶性细胞群体的概念。
