Adenomatous hyperplasia in the vicinity of small hepatocellular carcinoma

Authors

  • Akira Eguchi M.D.,

    Corresponding author
    1. The First Department of Pathology, Kurume University School of Medicine, Kurume-Shi, Fukuoka-Ken 830, Japan
    • The First Department of pathology, Kurume University School of Medicine, 67, Asahi-machi, Kurume-shi, Fukuoka, 830, Japan
    Search for more papers by this author
  • Osamu Nakashima,

    1. The First Department of Pathology, Kurume University School of Medicine, Kurume-Shi, Fukuoka-Ken 830, Japan
    Search for more papers by this author
  • Sadayuki Okudaira,

    1. The First Department of Pathology, Kurume University School of Medicine, Kurume-Shi, Fukuoka-Ken 830, Japan
    Search for more papers by this author
  • Shigetaka Sugihara,

    1. The First Department of Pathology, Kurume University School of Medicine, Kurume-Shi, Fukuoka-Ken 830, Japan
    Search for more papers by this author
  • Masamichi Kojiro

    1. The First Department of Pathology, Kurume University School of Medicine, Kurume-Shi, Fukuoka-Ken 830, Japan
    Search for more papers by this author

Abstract

The nodular lesions seen in the noncancerous areas of the 80 consecutively resected small hepatocellular carcinoma associated with cirrhosis were pathomorphologically studied. A total of 51 nodular lesions were found, and they were classified into the following four groups: large regenerative nodule (30 nodules), adenomatous hyperplasia (12 nodules), atypical adenomatous hyperplasia (4 nodules) and adenomatous hyperplasia containing cancerous foci (5 nodules). Grossly, all large regenerative nodules were well demarcated, but some of the adenomatous hyperplasia group were vaguely nodular. Atypical adenomatous hyperplasia and adenomatous hyperplasia containing cancerous foci accounted for 43% of the adenomatous hyperplasia group found in the vicinity of the 16 resected hepatocellular carcinoma (20%) out of 80 cases. The mean size (±S.D.) of the adenomatous hyperplasias containing cancerous foci, 15.8 ± 2.2 mm, was significantly larger than 10.1 ± 2.6 mm of the adenomatous hyperplasias (p < 0.01). All adenomatous hyperplasias containing cancerous foci and 75% of the atypical adenomatous hyperplasias demonstrated a marked fatty change, but none of the large regenerative nodules were accompanied by any fatty changes.

This study demonstrated the morphological transition from adenomatous hyperplasia to hepatocellular carcinoma that was suggestive of multistep hepatocarcinogenesis. As a result, it is predicted that approximately 20% of all hepatocellular carcinomas may have the potential for being of multicentric origin and that approximately 40% of adenomatous hyperplasias may undergo malignant transformation, but it is difficult to estimate the exact number of incidences. The presence of varying degrees of fatty change may be one of the significant morphological markers for a malignant transformation from adenomatous hyperplasia to hepatocellular carcinoma. We should also be aware that adenomatous hyperplasias larger than 1.5 cm in size might already contain cancerous foci somewhere in the nodule. Accordingly, adenomatous hyperplasia should be treated as a premalignant lesion. (HEPATOLOGY 1992;15:843–848).

Ancillary