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World J Gastroenterol. Nov 21, 2014; 20(43): 15955-15964
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.15955
Histopathology of hepatocellular carcinoma
Manuel Schlageter, Luigi Maria Terracciano, Salvatore D’Angelo, Paolo Sorrentino
Manuel Schlageter, Luigi Maria Terracciano, Department of Pathology, University Hospital Basel, 4031 Basel, Switzerland
Salvatore D’Angelo, Paolo Sorrentino, Liver Unit, Clinical and Experimental Hepatology, S.G. Moscati General Hospital, 83100 Avellino, Italy
Author contributions: Schlageter M conceived and wrote the article; Terracciano LM conceived and wrote the article; D’Angelo S conceived and supervised the article; Sorrentino P conceived and supervised the article.
Correspondence to: Paolo Sorrentino, MD, PhD, Liver Unit, Clinical and Experimental Hepatology, S.G. Moscati General Hospital, Via Otranto 2, 83100 Avellino, Italy. paolosorrmed@tin.it
Telephone: +39-347-5888993
Received: January 17, 2014
Revised: May 9, 2014
Accepted: July 22, 2014
Published online: November 21, 2014
Processing time: 306 Days and 20.9 Hours
Abstract

Hepatocellular carcinoma (HCC) is currently the sixth most common type of cancer with a high mortality rate and an increasing incidence worldwide. Its etiology is usually linked to environmental, dietary or life-style factors. HCC most commonly arises in a cirrhotic liver but interestingly an increasing proportion of HCCs develop in the non-fibrotic or minimal fibrotic liver and a shift in the underlying etiology can be observed. Although this process is yet to be completely understood, this changing scenario also has impact on the material seen by pathologists, presenting them with new diagnostic dilemmas. Histopathologic criteria for diagnosing classical, progressed HCC are well established and known, but with an increase in detection of small and early HCCs due to routine screening programs, the diagnosis of these small lesions in core needle biopsies poses a difficult challenge. These lesions can be far more difficult to distinguish from one another than progressed HCC, which is usually a clear cut hematoxylin and eosin diagnosis. Furthermore lesions thought to derive from progenitor cells have recently been reclassified in the WHO. This review summarizes recent developments and tries to put new HCC biomarkers in context with the WHOs reclassification. Furthermore it also addresses the group of tumors known as combined hepatocellular-cholangiocellular carcinomas.

Keywords: Histology; Pathology; Hepatocellular carinoma

Core tip: Hepatocellular carcinoma (HCC) is currently the sixth most common type of cancer with a high mortality rate and an increasing incidence worldwide. HCC most commonly occurs on ground of a cirrhotic liver but interestingly an increasing proportion of HCCs develop in the non-fibrotic or minimal fibrotic. Although this process is yet to be completely understood, this changing scenario also has impact on the material seen by pathologists, presenting them with new diagnostic dilemmas. This review summarizes recent developments and tries to put new HCC biomarkers in context with the WHOs reclassification.