Ductular reaction is helpful in defining early stromal invasion, small hepatocellular carcinomas, and dysplastic nodules

被引:78
作者
Park, Young Nyun
Kojiro, Masamichi
Di Tommaso, Luca
Dhillon, Amar R.
Kondo, Fukuo
Nakano, Masayuki
Sakamoto, Michiie
Theise, Neil D.
Roncalli, Massimo
机构
[1] Yonsei Univ, Coll Med, Dept Pathol, Seoul, South Korea
[2] Yonsei Univ, Coll Med, Inst Gastroenterol, Ctr Chron Metab Dis,Brain Korea Project Med Sci 2, Seoul, South Korea
[3] Kurume Univ, Sch Med, Dept Pathol, Kurume, Fukuoka 830, Japan
[4] Univ Milan, Dept Pathol, Humanities Clin Inst, Italian Sci Inst Res Hosp & Hlth Care,Sch Med, Milan, Italy
[5] UCL Royal Free & Univ Coll Med Sch, Dept Histopathol, London, England
[6] Funabashi Cent Hosp, Dept Pathol, Funabashi, Chiba, Japan
[7] Chiba Med Ctr, Dept Pathol, Chiba, Japan
[8] Keio Univ, Sch Med, Dept Pathol, Keio, Japan
[9] Beth Israel Deaconess Med Ctr, Dept Med, Div Digest Dis, New York, NY 10003 USA
[10] Beth Israel Deaconess Med Ctr, Dept Pathol, New York, NY 10003 USA
关键词
dysplastic nodule; hepatocellular carcinoma; ductular reaction; stromal invasion; cytokeratin; 7;
D O I
10.1002/cncr.22460
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND. Stromal invasion is 1 of the main features used to distinguish high-grade dysplastic nodules (DNs) from well-differentiated hepatocellular carcinomas (HCCs). The authors hypothesized that ductular reaction (DR) takes place around noninvasive hepatocellular nodules but not within the stroma contiguous to invasive HCC. METHODS. DR/cytokeratin 7 (CK7)-positive patterns were evaluated in 105 resected small hepatic nodules according to the level of invasion. The nodules were classified histologically prior to immunostaining as noninvasive (large regenerative nodules, low-grade DNs, and high-grade DNs), minimally invasive (early HCCs with a vaguely nodular type), and overtly invasive (typical HCCs with a distinctly nodular type) in a review by expert pathologists, the current gold standard. Intranodular DR (inner DR) and DR around the nodule periphery (outer DR) were assessed separately on a semiquantitative scale from 0 to 4+. RESULTS. DR was 3 or 4+ in the majority of noninvasive nodules (inner DR, 81%; outer DR, 91%), whereas DR was 0 or 1+ in overtly invasive HCCs (inner DR, 96%; outer DR, 81%). Minimally invasive HCCs showed an intermediate DR pattern (2 or 3+ inner DR, 75%; 2+ outer DR, 67%). DR characteristically was absent at the stromal-invasive, leading edge of tumor cells in both minimally invasive HCCs (focal loss of DR/CK7) and overtly invasive HCCs (diffuse loss of DR/CK7). The DR patterns in 41 needle-biopsy samples were similar to the patterns observed in resected nodules. CONCLUSIONS. DR/CK7 immunostaining may help to identify small foci of invasion and to distinguish noninvasive, high-grade DNs from both minimally invasive and overtly invasive HCCs.
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页码:915 / 923
页数:9
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