Thung S N, Hytiroglou P, Fiel I, Theise N
Lillian and Henry M. Stralton-Haas Popper Department of Pathology, The Mount Sinai Medical Center of the City University of New York, New York 10029, USA.
Princess Takamatsu Symp. 1995;25:171-8.
A significant proportion of patients with hepatocellular carcinoma (HCC) are infected with hepatitis C virus (HCV). This finding suggests that HCV infection is a major risk factor for the development of HCC. It is presently unclear whether HCV has a direct oncogenic effect on infected hepatocytes or whether continuous cell regeneration due to the chronic necroinflammatory process predisposes hepatocytes to mutations and malignant transformation. Except for rare cases, HCC in chronic HCV infection is always associated with cirrhosis. We examined a series of 138 consecutive cirrhotic livers with chronic hepatitis C that had been removed during transplantation for evidence of macroregenerative nodules (MRNs), liver cell dysplasia of large and small cell types, and HCC. MRNs and liver cell dysplasia are currently considered to be precursors of HCC. HCCs were present in 38 livers (28%) and were multifocal in half of the cases. MRNs were identified in 34 livers (25%). The number of MRNs ranged from 1 to 5 in 28 patients and was greater than 5 in 6 patients. In 14 of 34 livers with MRNs, there were associated HCCs (41%). Eight MRNs contained microscopic HCC. No microscopic HCC was found outside of MRNs; however, grossly apparent HCCs might have arisen from MRNs. Large liver cell dysplasia (LLCD) was frequently observed. It was present in 97 livers (70%) with or without MRNs and/or HCCs. Small liver cell dysplasia (SLCD) was seen in 8 livers with MRNs and/or HCCs and in 1 liver without MRN and HCC. These findings suggest that in chronic HCV infection, multifocal HCC is often found. MRN may represent one pathway in hepatocarcinogenesis. LLCD, similar to that found in chronic hepatitis B virus (HBV) infection, is a common finding in HCV-infected livers with cirrhosis, and appears not to be directly related to the development of HCC. SLCD is rarely seen, but may represent an important step in malignant transformation.
相当一部分肝细胞癌（HCC）患者感染了丙型肝炎病毒（HCV）。这一发现表明，HCV感染是HCC发生的主要危险因素。目前尚不清楚HCV是否对受感染的肝细胞具有直接致癌作用，或者慢性坏死性炎症过程导致的持续细胞再生是否使肝细胞易于发生突变和恶性转化。除罕见情况外，慢性HCV感染中的HCC总是与肝硬化相关。我们检查了一系列138例因慢性丙型肝炎而在移植时切除的肝硬化肝脏，以寻找大再生结节（MRN）、大小细胞类型的肝细胞发育异常和HCC的证据。MRN和肝细胞发育异常目前被认为是HCC的前驱病变。38例肝脏（28%）存在HCC，其中半数为多灶性。34例肝脏（25%）发现了MRN。28例患者的MRN数量为1至5个，6例患者的MRN数量超过5个。在34例有MRN的肝脏中，14例伴有HCC（41%）。8个MRN含有微小HCC。在MRN之外未发现微小HCC；然而，肉眼可见的HCC可能起源于MRN。经常观察到大肝细胞发育异常（LLCD）。97例肝脏（70%）存在LLCD，无论有无MRN和/或HCC。在8例有MRN和/或HCC的肝脏以及1例无MRN和HCC的肝脏中发现了小肝细胞发育异常（SLCD）。这些发现表明，在慢性HCV感染中，经常发现多灶性HCC。MRN可能代表肝癌发生的一条途径。LLCD与慢性乙型肝炎病毒（HBV）感染中发现的情况相似，是HCV感染的肝硬化肝脏中的常见表现，似乎与HCC的发生没有直接关系。SLCD很少见，但可能代表恶性转化中的一个重要步骤。
