Publication: Analytical histopathological diagnosis of small hepatocellular nodules in chronic liver diseases
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Date
1998
Authors
Nakanuma, Y. ; Hirata, K. ; Terasaki, S. ; Ueda, K. ; Matsui, O.
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Publisher
Murcia : F. Hernández
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DOI
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info:eu-repo/semantics/article
Description
Abstract
Due to the recent progress in radiology and
increased clinical and pathological interest, small
hepatocellular nodules about 1 cm in size are frequently
being detected in patients with chronic liver disease,
particularly liver cirrhosis. Two new types of small
hepatocellular nodules are now known: low-grade
hepatocellular carcinomas (HCC) and dysplastic
nodules, in addition to the previously known HCC
(classical) and regenerative nodules. Ultrasound-guided
needle biopsies from these nodules are routinely used
for the differential diagnosis. For comparison, a
simultaneous needle biopsy from the liver remote from
the nodule is strongly recommended. Low-grade HCC,
which are different from classical HCC in their
morphological atypia and also biological behaviors,
show local invasion into the portal tracts and
surrounding hepatic parenchyma, but not intrahepatic or
extrahepatic metastasis. Dysplastic nodules show mild
cellular and structural atypia, a finding which is not
sufficient for making a diagnosis of malignancy. An
increased nuclear/cytoplasmic (N/C) ratio and nuclear
crowding, small cell-dysplasia, increased cytoplasmic
staining, clear cell change, pseudogland formation, and
fatty change of hepatocytes are variably seen in these
nodules. Nuclear changes, local invasion to the portal
tract and surrounding liver, and loss of the reticulum
fibers along the hepatocytes are useful markers favoring
low-grade HCC rather than dysplastic nodules. These
low-grade HCC and dysplastic nodules should also be
distinguished from classical HCC as well as large-sized
regenerative nodules. A comparative analysis of the
histological findings observed in individual nodules is a
reasonable approach to differential diagnosis at present.
The recognition and analysis of these two new
hepatocellular nodules may augur a new horizon in the
study of hepatocellular neoplasm.
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