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Review
. 2021 Apr 27;13(4):393-410.
doi: 10.4254/wjh.v13.i4.393.

Pathologic and molecular features of hepatocellular carcinoma: An update

Mukul Vij  1 , Julien Calderaro  2
Affiliations
Review

Pathologic and molecular features of hepatocellular carcinoma: An update

Mukul Vij et al. World J Hepatol. .

Abstract

Morphological diversity and several new distinct pathologic subtypes of hepatocellular carcinoma (HCC) are now well-recognized. Recent advances in tumor genomics and transcriptomics have identified several recurrent somatic/genetic alterations that are closely related with histomorphological subtypes and have therefore, greatly improved our understanding of HCC pathogenesis. Pathologic subtyping allows for a diagnosis which is clinically helpful and can have important implication in patient prognostication as some of these subtypes are extremely aggressive with vascular invasion, early recurrence, and worst outcomes. Several targeted treatments are now being considered in HCC, and the reporting of subtypes may be quite useful for personalized therapeutic purpose. This manuscript reviews the recently identified histomorphological subtypes and molecular alterations in HCC.

Keywords: Fibrolamellar; Hepatocellular carcinoma subtypes; Macrotrabecular massive; Molecular alterations; Pathology; Steatohepatitic.

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Conflict of interest statement

Conflict-of-interest statement: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
International consensus group for hepatocellular neoplasia classification of small hepatocellular lesions. HCC: Hepatocellular carcinoma.
Figure 2
Figure 2
Dysplasia and gross morphology of hepatocellular carcinoma. A: Dysplastic foci with small cell change (hematoxylin and eosin); B: Nodular hepatocellular carcinoma (HCC) in a cirrhotic liver (arrow); C: Multinodular HCC in a cirrhotic liver (arrow); D: Multicentric HCC (arrow).
Figure 3
Figure 3
Well differentiated hepatocellular carcinoma. A: Early hepatocellular carcinoma (HCC) with pseudoacinar pattern [hematoxylin and eosin (H&E)]; B: Well differentiated HCC with thin trabeculae (H&E); C: Well differentiated HCC with pseudoacini (H&E); D: HCC with solid sheet growth pattern (H&E).
Figure 4
Figure 4
Hepatocellular carcinoma cytological features. A: Hepatocellular carcinoma (HCC) with fatty change [hematoxylin and eosin (H&E)]; B: Marked pleomorphism in an HCC (H&E); C: Foamy cell cytoplasm in an HCC (H&E); D: HCC with oncocytic cells (H&E).
Figure 5
Figure 5
Conventional and macrotrabecular massive hepatocellular carcinoma. A: Hyaline globules in a conventional hepatocellular carcinoma (HCC) [arrow, hematoxylin and eosin (H&E)]; B: Macrotrabecular massive HCC (H&E); C: Large macrotrabecular massive HCC with satellite nodule; D: Macrotrabecular massive HCC with vascular invasion (arrow, H&E).
Figure 6
Figure 6
Hepatocellular carcinoma subtypes. A: Hepatocellular carcinoma (HCC) with steatohepatitic pattern [hematoxylin and eosin (H&E)]; B: Sclerotic HCC (H&E); C: Fibrolamellar HCC with large cells and prominent nucleoli (H&E); D: Fibrolamellar HCC with lamellar fibrosis (H&E).
Figure 7
Figure 7
Hepatocellular carcinoma subtypes. A: Lymphoepithelioma like hepatocellular carcinoma (HCC) [hematoxylin and eosin H&E)]; B: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) with hepatocytic and cholangiocytic component (H&E); C: cHCC-CCA with stem/progenitor cell features (H&E); D: Cirrhotomimetic HCC with numerous tumor nodules.
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