HCC


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  • Clinical

    • 85% due to chronic viral infection: HBV, HCV
    • cirrhosis
    • other etiologies: EtOH, iron overload, hereditary hemochromatosis, alpha 1 antitrypsin deficiency
    • associations: elevated AFP

  • Histology

    • architecture
      • trabecular
      • pseudoglandular
      • compact/solid
    • cytology
      • classic: resembles hepatocytes
      • other variants: pleomorphic, clear cells, fatty change
      • other features: bile plugs, hyaline bodies, pale bodies, ground glass inclusions
    • other features
      • plates > 2 cells thick
      • pseudoglands: abnormal bile canaliculi between tumor cells, contains PAS+ pink fluid
      • capillarization: sinusoid endothelial cells become CD34+
      • neovascularization: unpaired arteries that are not part of portal triad
      • lacks portal tracts (entrapped portals may be seen in periphery)

  • Subtypes

  • Stains

    • HSP70 > 10%
    • glypican 3
    • glutamine synthetase > 10%
    • positive: HepPar1 (90%), CD34 stains sinusoids, AFP, CK8, CK18
    • negative: CK19, CK20, EMA

  • Grading

    • well-differentated: resembles normal hepatocytes with pseudoglands and fatty change, usually size < 2cm
    • moderately differentiated: plates > 2 cell thick, prominent nucleoli, usually size > 3cm
    • poorly differentiated: solid tumor nests, lack sinusoid, marked atypia/pleomorphism, large size
    • undifferentiated: solid, little cytoplasm, round or spindle cells
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