Histopathology of hepatocellular carcinoma -when and what (original) (raw)
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Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma
World journal of gastroenterology, 2018
Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical tr...
Canadian Association of Radiologists Journal, 2012
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and accounts for 80Vo of all liver tumours . Worldwide, HCC is the fifth most commonly diagnosed cancer, and ranks as the fourth leading cause of cancer-related deaths . Furthermore, the incidence rate of HCC has steadily increased over the past 3 decades within Canada and is projected to continue to increase over the next 10 years [2]. There are several well-established risk factors for the development of HCC, the most recognized being chronic hepatitis B and hepatitis C infection . Hepatitis B cariers have been reported to have a relative risk of HCC, which is 100 times greater than the background population, and this flgure is likely to be greater if there is established cirrhosis l4l. In fact, liver cirrhosis of any etiology,
Histopathology of hepatocellular carcinoma
World journal of gastroenterology : WJG, 2014
Hepatocellular carcinoma (HCC) is currently the sixth most common type of cancer with a high mortality rate and an increasing incidence worldwide. Its etiology is usually linked to environmental, dietary or life-style factors. HCC most commonly arises in a cirrhotic liver but interestingly an increasing proportion of HCCs develop in the non-fibrotic or minimal fibrotic liver and a shift in the underlying etiology can be observed. Although this process is yet to be completely understood, this changing scenario also has impact on the material seen by pathologists, presenting them with new diagnostic dilemmas. Histopathologic criteria for diagnosing classical, progressed HCC are well established and known, but with an increase in detection of small and early HCCs due to routine screening programs, the diagnosis of these small lesions in core needle biopsies poses a difficult challenge. These lesions can be far more difficult to distinguish from one another than progressed HCC, which is...
Hepatocellular carcinoma Diagnosis treatment and management
INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCES, 2024
Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer and the primary cause of cancer-related mortality. HCC ranks as the ninth most common cause of cancer-related fatalities in the US. Incident and death rates are still rising despite improvements in screening, prevention, and diagnosis and treatment technologies. Regardless of the cause, cirrhosis continues to be the primary risk factor for the development of HCC. There are separate risk factors for the development of cirrhosis associated with hepatitis B and C. Since alcohol misuse is five times more common in the US than hepatitis C, alcohol consumption continues to be a significant extra risk factor. Without pathologic confirmation, the diagnosis is confirmed. Screening involves 6-monthly serological indicators like ?-fetoprotein as well as radiologic testing including ultrasound, computed tomography, and magnetic resonance imaging. There are several treatment options available, however the only cures are orthotopic liver transplantation (OLT) and surgical resection. HCC typically develops in the context of advanced-stage chronic liver disease, though this is not always the case. Due to the variability of HCC and the occasionally challenging process of confirming hepatocellular distinction, the histological diagnosis of HCC presents numerous obstacles, especially when working with liver biopsy specimens. The spectrum of primary liver cancers includes a variety of tumours exhibiting both hepatocellular and cholangiocellular differentiation, with or without a progenitor/stem cell component present in the center. At either extreme of the spectrum are typical hepatocellular and cholangiocarcinomas. It can be very difficult to characterize combined (or mixed) hepatocellular-cholangiocarcinoma. Differentiating between HCC and its antecedents remains the primary issue for the histopathologist in advanced-stage chronic liver disease; nevertheless, this is rarely critical in the clinical context at this time. HCC originating in non-cirrhotic livers needs to be differentiated from other primary and extrahepatic tumours and from hepatocellular adenoma bearing in mind that progression
Contemporary role of liver biopsy in hepatocellular carcinoma
World Journal of Hepatology, 2018
A correct diagnosis of hepatocellular carcinoma (HCC) in cirrhotic patients with focal liver lesions is one of the most important issues nowadays. Probably one of the oldest debates in the hepatology community is whether to perform liver biopsy (LB) in all cirrhotic patients with focal liver lesions. We now face a time when oncology is moving towards personalized medicine. According to the current European Association for the study of Liver diseases HCC guidelines, LB has only a minor role in the management of HCC. However, the current recommendations were made more than five years ago. As time has passed, the development of high-throughput molecular technologies has helped reveal the main molecular mechanism involved in HCC development and progression. Several subtypes of HCC, with both molecular and histological characterization, have been described. Importantly, some of these subtypes have prognostic impact. In the context of personalized treatment, the role of LB will be carefully reconsidered. Until then, it is mandatory to know the various techniques of LB, their performances, complications and limitations. The balance of risk and benefit defines many of the decisions that we make as providers of medical care. In this review, we discuss not only the risks associated with LB, but also the benefits of biopsy in various clinical scenarios. Not long from now, the role of LB will be reconsidered. It is possible that we will go back in time and once again use biopsy for HCC diagnosis. Then again, we may move back to the future to try to improve the use of liquid biopsy in the follow-up of HCC patients after various treatment modalities.
Hepatocellular Carcinoma. Part 2: Clinical Presentation and Diagnosis
European medical journal, 2017
Clinical presentation of hepatocellular carcinoma (HCC) can vary from asymptomatic patients to patients presenting variable symptoms such as pain, lethargy, jaundice, hepatic encephalopathy, anasarca, ascites, variceal bleeding, diarrhoea, paraneoplastic symptoms, cutaneous manifestations, and abnormal laboratory values. Diagnosis of HCC is based on computed tomography (CT), magnetic resonance imaging (MRI), and tumour markers. The most commonly used is alpha fetoprotein. 1,2 MRI is the imaging method of choice, although it has decreased sensitivity in detecting lesions <2 cm. 3 Other possibilities include biomarkers such as embryonic antigen, protein antigen, enzymes and isoenzymes, cytokines, and genetic biomarkers. Liver biopsy is used in selected patients who do not present typical features of HCC on CT or MRI. Surveillance by ultrasound is recommended every 6 months in cirrhotic patients. The Barcelona Clinic Liver Cancer (BCLC) scoring system has been proposed for staging of HCC, and numerous scoring systems have been developed to evaluate progression and determine treatment possibilities; they take into account the clinical as well as the laboratory and pathological criteria, biomarkers, biopsy, and imaging methods.
Hepatocellular Carcinoma versus Other Carcinomas of Liver: Distinguishing Features
2005
Objective: To find out the helpful cytological features distinguishing between hepatocellular carcinoma (HCC) with other carcinomas of liver Study Design: Fine Needle Aspiration Cytology (FNAC) cases were selected in 35 patients on whom a diagnosis was rendered either of hepatocellular carcinoma or other carcinoma involving liver. The aspirates were examined for slide background, cellularity and specific cytoplasmic and nuclear features in both sets. Result: There were 20 cases of hepatocellular carcinoma (HCC) & 12 cases of other carcinoma involving liver. Six out of twelve In the current study we examined 12 cytological criteria out of which six were found to be of considerable help in distinguishing hepatocellular carcinoma (HCC) from other carcinoma involving liver. The hepatocellular carcinomas characteristically had central nuclei, discohesive cells, high cellularity and naked nuclei while hyperchromatic nuclei, eccentric nuclei and nuclear cytoplasmic ratio of >75% were the prominent features of other carcinoma involving liver. On the other hand coarse chromatin, nuclear molding and chromatin clearing of nuclei showed no significant difference in distinguishing hepatocellular carcinoma from other primary and metastatic carcinoma of the liver. Conclusion: Fine needle aspiration cytology (FNAC) of the liver is a very useful diagnostic modality to identify the vast majority of neoplasms of primary or metastatic nature. Meticulous attention to the nuclear features is vital in distinguishing hepatocellular carcinoma (HCC ) from other carcinomas of liver.
Diagnosis, staging and treatment of hepatocellular carcinoma
Brazilian Journal of Medical and Biological Research, 2004
Hepatocellular carcinomas are aggressive tumors with a high dissemination power. An early diagnosis of these tumors is of great importance in order to offer the possibility of curative treatment. For an early diagnosis, abdominal ultrasound and serum alpha-fetoprotein determinations at 6-month intervals are suggested for all patients with cirrhosis of the liver, since this disease is considered to be the main risk factor for the development of the neoplasia. Helicoidal computed tomography, magnetic resonance and/or hepatic arteriography are suggested for diagnostic confirmation and tumor staging. The need to obtain a fragment of the focal lesion for cytology and/or histology for a diagnosis of hepatocellular carcinoma depends on the inability of imaging methods to diagnose the lesion. Several classifications are currently available for tumor staging in order to determine patient prognosis. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to be the main factor related to patient survival. Classifications, however, fail to correlate treatment with prognosis and cannot suggest the ideal treatment for each tumor stage. The Barcelona Classification (BCLC) attempts to correlate tumor stage with treatment but requires prospective studies for validation. For single tumors smaller than 5 cm or up to three nodules smaller than 3 cm, surgical resection, liver transplantation and percutaneous treatment may offer good anti-tumoral results, as well as improved patient survival. Embolization or chemoembolization are therapeutic alternatives for patients who do not benefit from curative therapies.
Cytologic Criteria to Distinguish Hepatocellular Carcinoma from Nonneoplastic Liver
American Journal of Clinical Pathology, 1991
The authors reviewed a series of fine-needle aspiration biopsy (FNAB) specimens of the liver to identify useful cytologic criteria to distinguish hepatocellular carcinoma (HCC) from nonneoplastic liver. Ten cytologic features were examined in this study: high cellularity, acinar pattern, trabecular pattern, hyperchromasia, pleomorphism, irregularly granular chromatin, uniformly prominent nucleoli, multiple nucleoli, increased nuclear/cytoplasmic ratio, and atypical naked hepatocytic nuclei. These features were examined in a series of 82 FNAB specimens from 52 Fine-needle aspiration biopsy (FNAB) is an increasingly popular means to evaluate liver masses. 1 " 3 In a previous study, we identified key cytologic features that distinguished hepatocellular carcinoma (HCC) from metastatic neoplasms. 4 With the use of a step-wise logistic regression analysis, three cytologic features were identified that were useful in this differential diagnosis: polygonal cells with centrally placed nuclei, malignant cells separated by sinusoidal capillaries, and bile. However, the distinction between HCC and "normal" liver is often more difficult than that between HCC and a metastatic neoplasm. In the current study, we identified three key cytologic features that help to distinguish HCC from benign, nonneoplastic lesions in the liver.
Diagnosis and staging of hepatocellular carcinoma
Gastroenterology, 2004
Abbreviations used in this paper: AFP, ␣-fetoprotein; CT, computed tomography; DCP, des-carboxyprothrombin; EASL, European Association for the Study of the Liver; FISH, fluorescent in situ hybridization; HCC, hepatocellular carcinoma; MR, magnetic resonance; MRI, magnetic resonance imaging.