Adult-type hepatocellular carcinoma in the center of a fibrolamellar hepatocellular carcinoma

A large hepatic tumor was detected in the noncirrhotic liver of a 27-year-old female patient. The tumor was radiologically characterized by a peripheral mass encircling a central ovoid tumor, and was resected by an extended right hemihepatectomy. Histologic examination revealed that the peripheral and major component of the tumor represented a fibrolamellar hepatocellular carcinoma, whereas the central, well-demarcated tumor was a less well-differentiated adult-type hepatocellular carcinoma completely encircled by the former. Cells of the peripheral tumor mass abundantly expressed cytokeratin-7, typically present in the fibrolamellar variant, whereas no cytokeratin-7 immunoreactivity was found in the central tumor. To our knowledge, this is the first reported case of a not admixed but clearly separated evolution of these 2 histologic patterns within the same tumor, and suggests that the 2 types of hepatocellular carcinoma may share a common pathogenic pathway.     

Sarcoidosis-associated hepatocellular carcinoma

Sarcoidosis is a systemic granulomatous inflammation of unknown etiology, and seems to involve the liver parenchyma in most cases. However, sarcoidosis-associated hepatocellular carcinoma is rare. We report here a case in which a hepatocellular carcinoma occurred within the liver, which was probably involved as a result of systemic sarcoidosis. A 57-year-old Japanese man had been followed up for 2 years because of diabetic nephropathy and sarcoidosis. On admission for pneumonia, imaging studies revealed an unexpected hepatic tumor. Histology revealed a hepatocellular carcinoma accompanied by T-lymphocytic infiltration and marked granulomatous inflammation, which was surrounding some tumor nodules. The background liver parenchyma exhibited a moderate degree of fibrosis with granulomatous inflammation. The patient had no other apparent liver disease such as viral hepatitis, steatohepatitis, or primary biliary cirrhosis. Therefore, in the present case, sarcoidosis may be considered the probable background etiology for hepatocarcinogenesis.     

Fibrolamellar hepatocellular carcinoma

Fibrolamellar hepatocellular carcinoma (FLM) is a rare tumour that typically presents in young adults. It occurs in non-cirrhotic liver and is usually associated with normal serum alpha-fetoprotein. It is defined by a triad of morphological features: polygonal tumour cells with eosinophilic cytoplasm, prominent macronucleoli and lamellar fibrosis. A central scar can be present. The principal differential diagnosis is conventional hepatocellular carcinoma (HCC), especially the scirrhous variant. Acinar differentiation and focal mucin production are common and can be confused with adenocarcinoma. Focal neuroendocrine differentiation can occur and can be mistaken for neuroendocrine tumours. FLM also shows distinctive features at the molecular level; many of the commonly observed abnormalities in conventional HCC like p53 and β-catenin mutations are not observed in FLM. The extent of cytogenetic changes and CpG island methylation is low in FLM compared to conventional HCC. FLM is an aggressive neoplasm with 5-year survival of around 50%. Although the outcome in FLM has been considered more favourable compared to conventional HCC, this is likely to be related to absence of cirrhosis rather than unique morphological features of the tumour.     

Pedunculated hepatocellular carcinoma

A case of this rare exception to the common gross types of hepatocellular carcinoma is reported. The main clinico-pathological findings of this variant are summarized in the light of a review of the relevant literature. Emphasis is placed on the usefulness of the latest diagnostic procedures including echography and CT scans for an increased accuracy of the preoperative clinical diagnosis.     

Cytology of hepatocellular carcinoma

Twenty-five cases of cytologically and histologically confirmed hepatocellular carcinoma (HCC) were cytomorphologically analyzed using May-Grünwald-Giemsa (MGG)-stained aspiration smears and supplemented with special stains. The cell types were categorized as well differentiated (18 cases), vacuolated (four cases), giant cell (one case), and poorly differentiated (two cases). Glycogen staining was positive in 80% of the cases and hence served as a reliable parameter of diagnostic importance in HCC. Cytoplasmic hyaline bodies (14.6%) and bile pigment (17%), when present, were other important features supporting the diagnosis of HCC. Vacuolation of the cell cytoplasm (80%) was possibly related to glycogen accumulation. The cause of nuclear vacuolation (60%) and the significance of nuclear argyrophilia as markers of abnormal cell growth remain to be studied.     

Pathology of hepatocellular carcinoma

Rather rapid and brief over-view of pathology of hepatocellular carcinoma has been made, where the connection between morphology and virology or biochemistry is stressed as the main focus of today's pathology. Thus, existence of some relation between hepatitis virus and hepatocellualr carcinoma seems to be definite for us. However, it is still very difficult to decide whether the relationship is a direct or indirect one. High incidence of hepatocellular carcinoma also in Budd-Chiari's cirrhosis and schistoma-induced cirrhosis seems to suggest existence of the high risk type of cirrhosis for hepatocellular carcinoma development, irrespective of the cause of cirrhosis itself, although HB antigen might be playing some role in these cases especially in the latter.     

Recurrence of bronchioloalveolar carcinoma in transplanted lungs

BACKGROUND: Bronchioloalveolar carcinoma is a distinctive subtype of typical adenocarcinoma of the lung that tends to metastasize widely throughout the lungs but less commonly elsewhere. Because conventional therapies for intrapulmonary metastatic bronchioloalveolar carcinoma are generally ineffective, we treated seven patients who had intrapulmonary metastatic bronchioloalveolar carcinoma with lung transplantation. METHODS: Seven patients with biopsy-proved bronchioloalveolar carcinoma and no evidence of extrapulmonary disease received transplants of either one or two cadaveric lungs. At transplantation, all native lung tissue was removed and replaced with a donor lung or lungs. The patients received the usual post-transplantation care given at the institution. RESULTS: Four of the seven patients had recurrent bronchioloalveolar carcinoma within the donor lungs; the recurrences appeared from 10 to 48 months after transplantation. All recurrences were limited to the donor lungs. Histologic and molecular analyses showed that the recurrent tumors in three patients originated from the recipients of the transplants. CONCLUSIONS: Lung transplantation for bronchioloalveolar carcinoma is technically feasible, but recurrence of the original tumor within the donor lungs up to four years after transplantation was common.     

microRNA与肝癌

肝癌是世界上最常见的恶性肿瘤之一,其发病率和病死率极高。microRNA(miRNA)是一类单链的非编码RNA,通常在转录后水平调控基因的表达。最近多项研究表明miRNA在肝癌中发挥着重要作用,已经成为肝癌诊断、治疗中的一个靶标。     

miRNAs与肝细胞癌

最近发现一类小分子物质--microRNAs在肝细胞癌中异常表达,其中部分已被证实与肝细胞癌的发生发展密切有关.有些microRNAs与肝细胞癌的分型有关,提示microRNAs在肝细胞癌的诊断和预后判断中有着潜在的作用;有些microRNAs被证实为肝细胞癌发生的独立危险因素,为临床早期筛查和风险评估提供了分子标记,也为个体化治疗提供了分子依据.     

Morphometric analysis of hepatocellular carcinoma

Summary In order to characterize the cytological features of highly differentiated hepatocellular carcinoma (HCC), a comparative morphometric study was made by observing 30 cases of HCCs and controls (normal, cirrhotic, and atrophic livers). Among trabecular HCCs, normotrabecular subtype (1–2 cell thick cell plate) usually showed minimal cytological atypism and was categorized as well or highly differentiated HCC. Using an image analyzer, the following 4 parameters were applied to quantitate the hepatocyte changes: mean cell size ( ), mean nuclear size ( ), nucleocytoplasmic (N/C) ratio and a coefficient of variance (CV = index of anisokaryosis). In normotrabecular HCCs, was slightly but significantly reduced when compared with normal and cirrhotic livers (t-test:p<0.005). The value was further reduced in mid- and macrotrabecular HCCs. Normotrabecular HCCs showed almost the same value as normal and cirrhotic livers but displayed significantly a higher N/C value than those of controls (t-test:p<0.001). The N/C ratio became even greater in other types of HCCs. While CV was relatively constant in other HCC groups and controls, it was extremely high in the pleomorphic type of HCC and liver cell dysplasia.The results indicated that a reduction in and increase in N/C ratio, which appear as nuclear crowding in histological specimens, actually occurs in well differentiated HCC. For the histologic diagnosis of well differentiated HCC, it would be very important to examine liver specimens with these observations in mind.     

Lymphangitic spread of hepatocellular carcinoma

Pulmonary lymphangitic carcinomatosis is a well-documented phenomenon caused by spread of carcinoma to the pulmonary vasculature and lymphatics, often resulting in respiratory failure and cor pulmonale. It has been described in numerous types of carcinoma, most commonly occurring with carcinomas of the breast and stomach and with choriocarcinoma. We report the case of a patient who presented with increasing shortness of breath and dyspnea on exertion. Autopsy findings revealed diffuse pulmonary vascular spread of a hepatocellular carcinoma to the lungs. To our knowledge, this is the first reported case of lymphangitic spread of a hepatocellular carcinoma causing respiratory compromise (lymphangitic carcinomatosis).     

Endobronchial metastasis of hepatocellular carcinoma

Endobronchial metastasis (EBM) secondary to extrathoracic malignancies is rare among the various modes of pulmonary metastases. Of the many types of extrathoracic tumors capable of EBM, only one case of EBM from hepatocellular carcinoma has been reported, but radiologic findings were not described. We present the radiologic findings of surgically proven EBM in a patient with hepatocellular carcinoma. A chest radiograph revealed a tubular mass-like opacity in the right suprahilar region combined with mild volume decrease of the right upper lobe. Fiberoptic bronchoscopy had erroneously led to a diagnosis of endobronchial aspergilloma. The metastatic lesion was manifested as a branching pattern of enhanced endobronchial mass at the anterior segment of the right upper lobe on computed tomography.     

Ultrastructure of human hepatocellular carcinoma

Twelve human hepatocellular carcinomas (HCC) were studied ultramicroscopically. In the aspects of development of cytoplasmic organelles, well differentiated cancer cells were similar to the normal hepatocytes. On the other hand, poorly differentiated HCC cells contained little cytoplasmic organelle except for relatively developed rER and ribosomes. HCC cells showed not only several differentiations but also many degenerative changes, such as fatty metamorphosis, "dark" and "clear" cells, "fingerprint" formation and myelin-like figure, and the ultratructural alterations of the vessels among HCC cells could play one of the most important roles in causing these degenerative changes in human HCC cells.     

Fibrolamellar variant of hepatocellular carcinoma

A fibrolamellar variant of hepatocellular carcinoma with metastases in 2 regional lymph nodes was surgically removed from a girl, 17 years of age. This type of tumor has a typical histological pattern. Prognosis is found to be better than that of the common hepatocellular carcinoma.