Maeda T, Takenaka K, Adachi E, Matsumata T, Shirabe K, Honda H, Sugimachi K, Tsuneyoshi M
Department of Pathology II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Surg Oncol. 1995 Oct;60(2):75-9. doi: 10.1002/jso.2930600202.
A total of 128 surgically resected small hepatocellular carcinomas, measuring less than or equal to 3 cm in diameter, were studied by both macroscopic and histologic examinations. In 95 single nodular-type tumors of the 128 lesions, eight tumors were associated with the cancerous areas of well differentiated hepatocellular carcinoma around the nodule. These surrounding cancerous areas went undetected by both the preoperative radiological examinations and the gross findings of resected specimens. Based on the immunohistochemical findings, the labeling index, both of the proliferating cell nuclear antigen (PCNA) and of the Ki-67 in the surrounding cancerous areas, were lower than that of the main nodules but higher than in the nontumorous liver parenchyma in seven of eight cases. These results suggest that the main nodule was generated from the surrounding cancerous area, supporting the hypothesis of a stepwise progression of HCC. Even if the tumor seems to be a small and single nodular type, it is recommended that its surrounding areas should be closely examined and the surgical cutting margin should be made more than 1.0 cm away from the main nodule at hepatic resection.
对128例手术切除的直径小于或等于3 cm的小肝细胞癌进行了大体和组织学检查。在这128个病灶中的95个单结节型肿瘤中，有8个肿瘤与结节周围高分化肝细胞癌的癌灶相关。术前影像学检查和切除标本的大体检查均未发现这些周围癌灶。基于免疫组化结果，在8例中的7例中，周围癌灶中增殖细胞核抗原（PCNA）和Ki-67的标记指数均低于主结节，但高于非肿瘤性肝实质。这些结果表明主结节由周围癌灶产生，支持了HCC逐步进展的假说。即使肿瘤看似为小单结节型，建议在肝切除时对其周围区域进行仔细检查，手术切缘应距主结节1.0 cm以上。
