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Review
. 2019 Apr 14;25(14):1653-1665.
doi: 10.3748/wjg.v25.i14.1653.

Update on hepatocellular carcinoma: Pathologists' review

Tony El Jabbour  1 , Stephen M Lagana  2 , Hwajeong Lee  3
Affiliations
Review

Update on hepatocellular carcinoma: Pathologists' review

Tony El Jabbour et al. World J Gastroenterol. .

Abstract

Histopathologic diversity and several distinct histologic subtypes of hepatocellular carcinoma (HCC) are well-recognized. Recent advances in molecular pathology and growing knowledge about the biology associated with distinct histologic features and immuno-profile in HCC allowed pathologists to update classifications. Improving sub-classification will allow for more clinically relevant diagnoses and may allow for stratification into biologically meaningful subgroups. Therefore, immuno-histochemical and molecular testing are not only diagnostically useful, but also are being incorporated as crucial components in predicting prognosis of the patients with HCC. Possibilities of targeted therapy are being explored in HCC, and it will be important for pathologists to provide any data that may be valuable from a theranostic perspective. Herein, we review and provide updates regarding the pathologic sub-classification of HCC. Pathologic diagnostic approach and the role of biomarkers as prognosticators are reviewed. Further, the histopathology of four particular subtypes of HCC: Steatohepatitic, clear cell, fibrolamellar and scirrhous - and their clinical relevance, and the recent consensus on combined HCC-cholangiocarcinoma is summarized. Finally, emerging novel biomarkers and new approaches to HCC stratification are reviewed.

Keywords: Classification; Hepatocellular carcinoma; Review; Subtype; Update.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest.

Figures

Figure 1
Figure 1
Steatohepatitic hepatocellular carcinoma. Tumoral cells show features of steatohepatitis including steatosis, ballooning and Mallory-Denk bodies (Hematoxylin and eosin stain, × 200).
Figure 2
Figure 2
Fibrolamellar hepatocellular carcinoma. Multiple fibrous septa composed of parallel collagen fibers separate tumoral trabeculae (Hematoxylin and eosin stain, × 100).
Figure 3
Figure 3
Scirrhous hepatocellular carcinoma. Bands of dense fibrosis separate cords and nests of tumoral cells (Hematoxyin and eosin stain, × 200).
Figure 4
Figure 4
Combined hepatocellular carcinoma-cholangiocarcinoma. Areas of conventional hepatocellular carcinoma (lower mid to right) are admixed with areas of discrete glands formation (upper left) (Hematoxylin and eosin stain, × 40).
See this image and copyright information in PMC

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