Okuda K
Department of Medicine, Chiba University School of Medicine, Japan.
J Gastroenterol Hepatol. 1997 Oct;12(9-10):S314-8. doi: 10.1111/j.1440-1746.1997.tb00515.x.
The histopathology and clinical picture of hepatocellular carcinoma (HCC) varies between individual patients and regions. These variations are perhaps due to differences in the genetic alterations that precede hepatocarcinogenesis. In this study, the clinicopathological features of HCC were compared between southern African blacks and Japanese, indicating large differences in the frequency of underlying cirrhosis, grade of cancer cell differentiation and clinical course. Intra-abdominal bleeding and febrile, rapidly progressive HCC are more common among blacks. Such a difference is accounted for, in part, by frequent encapsulation of the tumour which is well differentiated, and grows slowly in an expanding fashion in Japan. Encapsulated HCC was not seen among the black patients studied. Other distinct clinicopathological types discussed in this paper include diffuse-type HCC which is usually caused by multiple portal spread occurring almost simultaneously; the clinical course is fulminant. Sclerosing carcinoma is frequently associated with hypercalcaemia in the United States, but not in Japan. Fibrolamellar carcinoma is nearly non-existent in Asia, whereas it is common among young adults in the West. Its prognosis is generally better than ordinary HCC. Hepatocellular carcinoma has a strong propensity to invade vessel and duct systems. Portal invasion does not produce distinct clinical signs although it may aggravate portal hypertension. Patients with tumour occlusion in the major portal vein may give rise to ischaemic hepatitis when blood pressure drops suddenly in the preterminal stage. Liver parenchyma develops submassive necrosis and clinically there is an acute rise in alanine aminotransferase (ALT). Invasion into a major hepatic vein and the inferior vena cava also occurs, but less frequently compared with portal invasion. The patient can live even with a tumour thrombus in the atrium crossing the tricuspid valves. Intraductal invasion causes acute jaundice as well as an occasional haemobilia with pain. We recently found that a distinct pathological type called 'extrahepatic growth' or 'pedunculated HCC' develops as a result of fusion of right-sided adrenal metastasis of HCC and the liver, perhaps through the 'adreno-hepatic fusion' which is rather common in cirrhotic livers.
肝细胞癌（HCC）的组织病理学和临床表现因个体患者及地区而异。这些差异可能归因于肝癌发生之前基因改变的不同。在本研究中，对南部非洲黑人和日本人的HCC临床病理特征进行了比较，结果表明在潜在肝硬化的发生率、癌细胞分化程度及临床病程方面存在很大差异。腹腔内出血以及发热、快速进展的HCC在黑人中更为常见。这种差异部分是由于在日本肿瘤常被包裹，分化良好，呈膨胀性缓慢生长。在所研究的黑人患者中未发现有包膜的HCC。本文讨论的其他独特临床病理类型包括弥漫型HCC，其通常由几乎同时发生的多灶门静脉播散引起；临床病程凶险。在美国，硬化性癌常伴有高钙血症，而在日本则不然。纤维板层癌在亚洲几乎不存在，而在西方的年轻人中较为常见。其预后通常优于普通HCC。肝细胞癌极易侵犯血管和胆管系统。门静脉侵犯虽可能加重门静脉高压，但不会产生明显的临床体征。在终末期前血压突然下降时，主要门静脉被肿瘤阻塞的患者可能会发生缺血性肝炎。肝实质出现亚大块坏死，临床上丙氨酸转氨酶（ALT）急剧升高。侵犯主要肝静脉和下腔静脉的情况也会发生，但与门静脉侵犯相比频率较低。即使肿瘤血栓穿过三尖瓣进入心房，患者仍可存活。胆管内侵犯会导致急性黄疸，偶尔还会引起伴有疼痛的胆道出血。我们最近发现，一种名为“肝外生长”或“带蒂HCC”的独特病理类型是由于HCC的右侧肾上腺转移与肝脏融合所致，可能是通过在肝硬化肝脏中相当常见的“肾上腺 - 肝融合”形成的。
