Multiple occurrence of borderline hepatocellular nodules in human cirrhotic livers: possible multicentric origin of hepatocellular carcinoma.

Borderline hepatocellular nodules (BHN), atypical adenomatous hyperplasia, macroregenerative nodule type II or dysplastic nodules in the cirrhotic liver are considered to be important prcancerous lesions transforming to hepatocellular carcinoma (HCC). In order to evaluate the uni- or multicentric origin of BHN and HCC arising from BN, we surveyed 30 cirrhotic livers with BHNs that had been surgically resected or autopsied during 1973-1993. Among the 30 cirrhotic livers with BHNs, two or more BHNs were present in a single cirrhotic liver in 10 (33%) cases, while only one BHN was present in a single cirrhotic liver in the remaining 20 (67%) cases. The mean number of BHN in a cirrhotic liver with multiple BHNs was 3.5. Carcinomatous foci were present within BHN in 6 (60%) of the 10 cirrhotic livers with multiple BHNs, while they were present in 4 (20%) of the 20 cirrhotic livers with a single BHN; this difference was statistically significant (P < 0.05). Coexistance of HCC was noted in 8 (80%) of the 10 cirrhotic livers with multiple BHNs, and in 3 (15%) of the 20 cirrhotic livers with a single BHN; this difference was statistically significant (P < 0.01). There were no significant differences in age, sex, aetiology and morphology between cirrhotic livers with multiple BHNs and those with a single BHN. These data suggest that BHN and HCC arising from BHN may be of multicentric origin.