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Preneoplastic lesions in chronic hepatitis C
S N Thung1, P Hytiroglou, I Fiel
1Lillian and Henry M. Stralton-Haas Popper Department of Pathology, The Mount Sinai Medical Center of the City University of New York, New York 10029, USA.
Princess Takamatsu Symposia
|January 1, 1995
Summary
Hepatocellular carcinoma (HCC) is often multifocal in patients with chronic hepatitis C virus (HCV) infection. Macroregenerative nodules (MRNs) may be a precursor pathway, while small cell liver dysplasia (SLCD) is a potential step in malignant transformation.
Area of Science:
- Hepatology
- Oncology
- Virology
Background:
- Hepatocellular carcinoma (HCC) is frequently associated with chronic hepatitis C virus (HCV) infection.
- The exact mechanism of HCV-induced HCC, whether direct oncogenesis or chronic inflammation-driven regeneration, remains unclear.
- HCC in chronic HCV infection typically occurs in the context of cirrhosis.
Purpose of the Study:
- To investigate the prevalence and potential precursor lesions of HCC in cirrhotic livers from patients with chronic HCV infection.
- To examine the relationship between macroregenerative nodules (MRNs), liver cell dysplasia (LCD), and HCC.
- To elucidate potential pathways in HCV-related hepatocarcinogenesis.
Main Methods:
- Histopathological examination of 138 cirrhotic livers from patients with chronic hepatitis C undergoing transplantation.
- Assessment for the presence of macroregenerative nodules (MRNs), large cell liver cell dysplasia (LLCD), small cell liver cell dysplasia (SLCD), and HCC.
- Correlation of these findings to determine potential precursor-lesion relationships.
Main Results:
- HCC was found in 28% of livers, often multifocal.
- MRNs were identified in 25% of livers, with 41% of these livers also having associated HCC.
- Microscopic HCC was exclusively found within MRNs, suggesting MRNs as a potential origin.
- LLCD was common (70%) but not directly linked to HCC development.
- SLCD was rare but potentially significant in malignant transformation.
Conclusions:
- Multifocal HCC is common in HCV-infected cirrhotic livers.
- MRNs represent a potential pathway in HCV-related hepatocarcinogenesis.
- SLCD may be a critical step in the malignant transformation of hepatocytes in HCV infection, whereas LLCD appears less directly involved.