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Analytical histopathological diagnosis of small hepatocellular nodules
in chronic liver diseases
Y. Nakanuma1, K. Hirata1, S. Terasaki2, K. Ueda3 and O.
Matsui3
Departmentments of 1Pathology (II), 2Internal Medicine
(I) and 3Radiology, Kanazawa University School of Medicine, Kanazawa, Japan
Offprint requests to: Dr. Yasuni
Nakanuma, MD, Second Department of Pathology, Kanazawa University School
of Medicine, Kanazawa 920-8640, Japan
Summary. 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. Histol.
Histopathol. 13, 1077-1087 (1998)
Key words: Hepatocellular carcinoma,
Low-grade hepatocellular carcinoma, Classical hepatocellular carcinoma,
Dysplastic nodule, Large regenerative nodule
DOI: 10.14670/HH-13.1077
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