Terada T, Terasaki S, Nakanuma Y
Second Department of Pathology, Kanazawa University School of Medicine, Japan.
Cancer. 1993 Sep 1;72(5):1551-6. doi: 10.1002/1097-0142(19930901)72:5<1551::aid-cncr2820720511>3.0.co;2-q.
Adenomatous hyperplasia (AH), also called macroregenerative nodule, of the cirrhotic liver is currently considered to be a preneoplastic or early neoplastic lesion in human hepatocellular carcinogenesis.
The authors surveyed 209 consecutive cirrhotic livers from patients who had undergone autopsy at our laboratory during the last 18 years (1974-1991), and examined the prevalence and clinicopathologic characteristics of cirrhotic livers with AH. AH was classified into two types: ordinary and atypical. Ordinary AH (OAH) is devoid of hepatocellular atypia, whereas atypical AH (AAH) consists of atypical hepatocytes equivocal as to benignity and malignancy and occasionally contains overt malignant foci.
A total of 123 AH were found in 45 (21.5%) of the 209 cirrhotic livers; 38 AAH were found in 12 cirrhotic livers (5.7%), and 85 OAH was found in 41 cirrhotic livers (19.6%). Nineteen AAH contained overt malignant hepatocellular foci. Comparing the first 9 years (1974-1982) with the latter 9 years (1983-1991), 4 (3.8%) of 104 cirrhotic livers harbored AAH in the first period, and 8 (7.4%) of 105 cirrhotic livers contained AAH in the latter period. Sixteen (15.4%) of 104 cirrhotic livers harbored OAH in the first period, and 25 (23.8%) of 105 cirrhotic livers contained OAH in the latter period. Etiology of the 12 cirrhotic livers with AAH was as follows: 1 was hepatitis B virus, 10 were non-A non-B hepatitis virus, and 1 was primary biliary cirrhosis. Etiology of 41 cirrhotic livers with OAH was as follows: 16 were hepatitis B virus, 18 were non-A non-B hepatitis virus, and 7 were other causes. AAH occurred commonly in mixed nodular cirrhosis, whereas OAH occurred usually in macronodular or mixed nodular cirrhosis. All 12 cirrhotic livers with AAH were associated with hepatocellular carcinoma (HCC), particularly HCC of nodular type, whereas 17 cirrhotic livers with OAH were associated with HCC and the remaining 24 cirrhotic livers with OAH were not associated with HCC.
These results suggest that the number of cirrhotic livers with AH is increasing gradually, and that cirrhotic livers with AAH are characterized by the association with non-A non-B hepatitis virus as well as simultaneous occurrence of HCC. Thus, AAH may be an important preneoplastic lesion in cirrhotic livers associated with non-A non-B hepatitis virus (probably hepatitis C virus).
肝硬化肝脏的腺瘤样增生（AH），也称为大再生结节，目前被认为是人类肝细胞癌发生过程中的一种癌前或早期肿瘤性病变。
作者调查了过去18年（1974 - 1991年）在我们实验室接受尸检的患者的209例连续性肝硬化肝脏，并检查了伴有AH的肝硬化肝脏的患病率及临床病理特征。AH分为两种类型：普通型和非典型型。普通AH（OAH）无肝细胞异型性，而非典型AH（AAH）由良性和恶性不明确的异型肝细胞组成，偶尔含有明显的恶性病灶。
在209例肝硬化肝脏中的45例（21.5%）中总共发现123个AH；在12例肝硬化肝脏（5.7%）中发现38个AAH，在41例肝硬化肝脏（19.6%）中发现85个OAH。19个AAH含有明显的恶性肝细胞病灶。将前9年（1974 - 1982年）与后9年（1983 - 1991年）进行比较，104例肝硬化肝脏中有4例（3.8%）在前一时期有AAH，105例肝硬化肝脏中有8例（7.4%）在后一时期有AAH。104例肝硬化肝脏中有16例（15.4%）在前一时期有OAH，105例肝硬化肝脏中有25例（23.8%）在后一时期有OAH。12例伴有AAH的肝硬化肝脏的病因如下：1例为乙型肝炎病毒，10例为非甲非乙型肝炎病毒，1例为原发性胆汁性肝硬化。41例伴有OAH的肝硬化肝脏的病因如下：16例为乙型肝炎病毒，18例为非甲非乙型肝炎病毒，7例为其他原因。AAH常见于混合结节性肝硬化，而OAH通常见于大结节性或混合结节性肝硬化。所有12例伴有AAH的肝硬化肝脏均与肝细胞癌（HCC）相关，尤其是结节型HCC，而17例伴有OAH的肝硬化肝脏与HCC相关，其余24例伴有OAH的肝硬化肝脏与HCC无关。
这些结果表明，伴有AH的肝硬化肝脏数量正在逐渐增加，伴有AAH的肝硬化肝脏的特征是与非甲非乙型肝炎病毒相关以及同时发生HCC。因此，AAH可能是与非甲非乙型肝炎病毒（可能是丙型肝炎病毒）相关的肝硬化肝脏中的一种重要癌前病变。
