Preneoplastic lesions in human hepatocarcinogenesis

Area of Science:

• Hepatology and Cancer Research
• Gastroenterology
• Oncology

Background:

• Chronic liver diseases can progress to hepatocellular carcinoma (HCC) through preneoplastic lesions.
• Identifying and understanding these early lesions is vital for therapeutic and clinical management strategies.
• Small-cell dysplastic foci represent the earliest recognizable precursor lesions in HCC development.

Purpose of the Study:

• To provide a comprehensive review of current concepts regarding preneoplastic lesions in chronic liver diseases.
• To highlight the significance of microscopical and macroscopical precursor lesions in hepatocarcinogenesis.
• To discuss the clinical and molecular implications of different types of dysplastic lesions.

Main Methods:

• Review of existing clinicopathological and molecular studies on preneoplastic lesions in chronic liver diseases.
• Analysis of the role of small-cell dysplasia, large-cell dysplasia, and dysplastic nodules (DNs) in HCC development.
• Discussion of diagnostic challenges, particularly differentiating DNs from early HCC using imaging techniques.

Main Results:

• Small-cell dysplastic foci are the earliest HCC precursors, while large-cell dysplasia has predictive value.
• High-grade dysplastic nodules (HGDNs) carry a risk of malignant transformation, necessitating further study.
• Regenerative nodules are not considered a distinct step in hepatocarcinogenesis.

Conclusions:

• Further clinicopathological and molecular studies are essential for the identification and optimal management of DNs.
• Investigating HGDNs and small HCCs can elucidate the genetic mechanisms of malignant transformation.
• Well-chosen animal models are crucial for unraveling human HCC development.