Okuda K, Nakashima T, Obata H, Kubo Y
Gastroenterology. 1977 Jul;73(1):109-15.
Sixteen necropsies and 4 cases of hepatic resection in which the liver had a solitary hepatocellular carcinoma smaller than 4.5 cm, or a few tumor nodules smaller than 3.5 cm, have been analyzed. Clinically, these patients presented with signs and symptoms compatible with cirrhosis and, of the 16 autopsy cases only 2 had been diagnosed correctly. In all but 4 cases, the noncancerous parenchyma showed advanced cirrhosis of the mixed type, with irregularly sized multilobular nodules and thin strands of stroma, different from typical alcoholic cirrhosis. The primary lesion was grossly encapsulated in the majority, suggesting a slow, expanding growth. Histologically, most primaries were relatively well differentiated. Serum alpha-fetoprotein was generally low, and it served as the major diagnostic clue in only 5 cases. In patients with mildly abnormal alpha-fetoprotein levels, continuous monitoring seems important in order to detect a steady rise, the first warning for tumor growth.
对16例尸检病例和4例肝切除术病例进行了分析，这些病例的肝脏有单个直径小于4.5 cm的肝细胞癌，或几个直径小于3.5 cm的肿瘤结节。临床上，这些患者表现出与肝硬化相符的体征和症状，在16例尸检病例中只有2例得到了正确诊断。除4例病例外，其余病例的非癌实质均显示为混合型晚期肝硬化，有大小不一的多小叶结节和细的间质条索，不同于典型的酒精性肝硬化。大多数原发性病变肉眼可见有包膜，提示生长缓慢、呈膨胀性。组织学上，大多数原发性肿瘤分化相对良好。血清甲胎蛋白一般较低，仅在5例病例中作为主要诊断线索。对于甲胎蛋白水平轻度异常的患者，持续监测似乎很重要，以便检测到其稳步上升，这是肿瘤生长的首个警示信号。
