Park Y N, Yang C P, Fernandez G J, Cubukcu O, Thung S N, Theise N D
Department of Pathology, Yonsei Medical Center, Seoul, Korea.
Am J Surg Pathol. 1998 Jun;22(6):656-62. doi: 10.1097/00000478-199806000-00002.
The blood supply of hepatocellular carcinoma (HCC) is primarily arterial. Recent studies reported differences of vascular, especially arterial, supply among low- and high-grade dysplastic nodules and HCC. We assessed arterialization using monoclonal antibody specific for smooth muscle actin as well as simultaneous changes in sinusoidal capillarization in cirrhotic nodules, dysplastic nodules, and HCC. We immunohistochemically stained 56 cirrhotic nodules, 20 low-grade dysplastic nodules, 27 high-grade dysplastic nodules, and 20 HCCs for alpha smooth muscle actin (to identify unpaired arteries (i.e., arteries not accompanied by bile ducts) and CD34 (indicating sinusoidal capillarization). Distribution and number of unpaired arteries and distribution of sinusoidal capillarization were graded semiquantitatively. Unpaired arteries were rare in cirrhotic nodules, significantly more common in dysplastic nodules of both types (p < 0.00001), and most common in HCC. Sinusoidal capillarization was least common in cirrhotic nodules, significantly more common in dysplastic nodules (p < 0.0035), and most common in HCC. No topographic relationship between unpaired arteries and sinusoidal capillarization was identified. These findings showed that (1) distributions of sinusoidal capillarization and unpaired arteries in dysplastic nodules are intermediate between those in cirrhotic nodules and HCC, supporting dysplastic nodules as premalignant lesions; (2) unpaired arteries are histologically useful for distinguishing dysplastic nodules from large cirrhotic nodules; and (3) areas of sinusoidal capillarization within dysplastic nodules are unrelated to location of arterialization.
肝细胞癌（HCC）的血液供应主要是动脉性的。最近的研究报道了低级别和高级别发育异常结节以及HCC之间血管供应，尤其是动脉供应的差异。我们使用针对平滑肌肌动蛋白的单克隆抗体评估动脉化情况，并同时观察肝硬化结节、发育异常结节和HCC中窦状毛细血管化的变化。我们对56个肝硬化结节、20个低级别发育异常结节、27个高级别发育异常结节和20个HCC进行免疫组织化学染色，检测α平滑肌肌动蛋白（以识别不成对动脉，即不伴有胆管的动脉）和CD34（指示窦状毛细血管化）。对不成对动脉的分布和数量以及窦状毛细血管化的分布进行半定量分级。不成对动脉在肝硬化结节中很少见，在两种类型的发育异常结节中明显更常见（p < 0.00001），在HCC中最常见。窦状毛细血管化在肝硬化结节中最不常见，在发育异常结节中明显更常见（p < 0.0035），在HCC中最常见。未发现不成对动脉与窦状毛细血管化之间存在地形关系。这些发现表明：（1）发育异常结节中窦状毛细血管化和不成对动脉的分布介于肝硬化结节和HCC之间，支持发育异常结节作为癌前病变；（2）不成对动脉在组织学上有助于将发育异常结节与大的肝硬化结节区分开来；（3）发育异常结节内窦状毛细血管化区域与动脉化位置无关。
