山梨医科大学雑誌　第6巻4号　193-206(1991)

Histopathological Analysis of Intrahepatic Multiple Hepatocellular
Carcinomas - Possibility of Differential Didgnosis of Their Origins
by Clonal Study

Masanori MATSUDA, Masayuki YAMAMOTO, Kaoru NAGAHORI, Kazuo MIURA,
and Yoshiro MATSUMOTO

Abstract: We selected 7 (23.3%) synchronously occurring multicentric hepatocellular carcinomas (HCC) from the resected liver specimens of 30 cases of HCC with multiple lesions. We used the following pathological criteria for selection. 1) Remote and smaller nodules showing microscopically well-differentiated HCC, besides the major nodule showing poorer differentlation; 2) multiple well-differentiated HCC; and 3) multiple HCC indicating "nodule-in-nodule" form. In 7 patients with synchronous multicentric HCC lesions (MC), less microscopic infiltration of tumor capsule (MC=42.9%, IM=73.9%) and invasion of portal vein (MC=28.6%, IM=60.9%) were observed than in the main lesions in 25 cases of intrahepatic metastatic group (IM). In MC group, non-cancerous liver tissue indicated chronic hepatitis in 4 cases and liver cirrhosis in 3 cases, while the non-cancerous liver tissue in IM group indicated chronic hepatitis in 3 cases, liver cirrhosis in 14 cases, and liver fibrosis in 6 cases. In 3 HBV carriers whose clinical history or histological analysis had suggested multicentric occurrence, clonal analysis, using Southern blot hybridization technique, was performed to ascertain multicentricity. In 2 patients, analysis of the intergration patterns of HBV DNA to multiple HCC was helpful in determining whether tumor origin was multicentric or metastatic, but in one patient whose lesions were very well-differentiated HCC and contained interior portal structures, clonal analysis did not help in this determination, as no discrete bands appeared.
From a clinical viewpoint, we believe that the determination of clonarity of intrahepatic multiple HCC become more important for treatment of HCC patients.

Key words: Hepatocellular carcinoma, Multicentric occurrence, Intrahepatic metastasis, Southern blot hybridization, Hepatitis B virus DNA integration




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