51
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Huang SF, Chang IC, Hong CC, Yen TC, Chen CL, Wu CC, Tsai CC, Ho MC, Lee WC, Yu HC, Shen YY, Eng HL, Wang J, Tseng HH, Jeng YM, Yeh CT, Chen CL, Chen PJ, Liaw YF. Metabolic risk factors are associated with non-hepatitis B non-hepatitis C hepatocellular carcinoma in Taiwan, an endemic area of chronic hepatitis B. Hepatol Commun 2018; 2:747-759. [PMID: 29881825 PMCID: PMC5983169 DOI: 10.1002/hep4.1182] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/23/2018] [Accepted: 03/17/2018] [Indexed: 12/28/2022] Open
Abstract
Metabolic risk factors, such as obesity, fatty liver, high lipidemia, and diabetes mellitus are associated with increased risk for nonviral hepatocellular carcinoma (HCC); however, few nonviral HCC studies have stratified patients according to underlying etiologies. From 2005 to 2011, 3,843 patients with HCC were recruited into the Taiwan Liver Cancer Network. Of these patients, 411 (10.69%) who were negative for hepatitis B virus (HBV), surface antigen, HBV DNA, and anti-hepatitis C virus (HCV) antibody were classified as non-HBV non-HCV (NBNC)-HCC. Detailed clinical analyses of these patients were compared with age- and sex-matched patients with HBV-HCC or HCV-HCC for the associated metabolic risk factors. For this comparison, 420 patients with HBV-HCC and 420 patients with HCV-HCC were selected from the 3,843 patients with HCC. Multivariate analyses showed fatty liver (by echography), high triglyceride levels (>160 mg/dL), and diabetes mellitus history to be significantly associated only with NBNC-HCC and not with the matched patients with HBV- or HCV-HCC. When the patients with HCC were further divided into four groups based on history of alcoholism and cirrhotic status, the group without alcoholism and without cirrhosis exhibited the strongest association with the metabolic risk factors. Based on trend analyses, patients with NBNC-HCC with or without alcoholism were significantly different from the matched patients with HBV- or HCV-HCC, except for patients with alcoholism and cirrhosis, in having more than two of the above three risk factors. Conclusion: Metabolic risk factors are significantly associated with nonviral HCC, especially for patients without alcoholism in Taiwan. Because the prevalence of viral HCC is decreasing due to the success of universal vaccination and antiviral therapy, strategies for cancer prevention, prediction, and surveillance for HCC will require modification. (Hepatology Communications 2018;2:747-759).
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Affiliation(s)
- Shiu-Feng Huang
- Institute of Molecular and Genomic Medicine National Health Research Institutes Miaoli Taiwan.,Department of Anatomic Pathology, Linko Chang Gung Memorial Hospital Chang-Gung University Taoyuan Taiwan.,Department of Anatomical Pathology Chung-Shan Medical University Hospital Taichung Taiwan
| | - Il-Chi Chang
- Institute of Molecular and Genomic Medicine National Health Research Institutes Miaoli Taiwan.,Liver Research Unit, Linko Chang Gung Memorial Hospital Chang-Gung University Taoyuan Taiwan
| | - Chih-Chen Hong
- Institute of Molecular and Genomic Medicine National Health Research Institutes Miaoli Taiwan.,Liver Research Unit, Linko Chang Gung Memorial Hospital Chang-Gung University Taoyuan Taiwan
| | - Tseng-Chang Yen
- Department of Applied Mathematics and Institute of Statistics National Chung-Hsing University TaiChung Taiwan
| | - Chao-Long Chen
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital Chang-Gung University Kaohsiung Taiwan
| | - Cheng-Chung Wu
- Department of General Surgery Taichung Veteran General Hospital Taichung Taiwan
| | - Cheng-Chung Tsai
- Department of General Surgery Kaohsiung Veteran General Hospital Kaohsiung Taiwan
| | - Ming-Chih Ho
- Department of General Surgery National Taiwan University Hospital Taipei Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Linko Chang Gung Memorial Hospital Chang-Gung University Taoyuan Taiwan
| | - Hsien-Chung Yu
- Department of Hepatogastroenterology Kaohsiung Veteran General Hospital Kaohsiung Taiwan
| | - Ying-Ying Shen
- Core Pathology Laboratory National Health Research Institutes Miaoli Taiwan
| | - Hock-Liew Eng
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital Chang-Gung University Kaohsiung Taiwan
| | - John Wang
- Department of Pathology Taichung Veteran General Hospital Taichung Taiwan
| | - Hui-Hwa Tseng
- Department of Pathology Kaohsiung Veteran General Hospital Kaohsiung Taiwan
| | - Yung-Ming Jeng
- Department of Pathology National Taiwan University Hospital Taipei Taiwan
| | - Chau-Ting Yeh
- Liver Research Unit, Linko Chang Gung Memorial Hospital Chang-Gung University Taoyuan Taiwan
| | - Chi-Ling Chen
- Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan
| | - Pei-Jer Chen
- Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan
| | - Yun-Fan Liaw
- Liver Research Unit, Linko Chang Gung Memorial Hospital Chang-Gung University Taoyuan Taiwan
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Fatty Liver Disease and Hepatocellular Carcinoma: The Pathologist's View. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1032:55-69. [PMID: 30362090 DOI: 10.1007/978-3-319-98788-0_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic alcohol misuse and progressed nonalcoholic fatty liver disease (NAFLD) due to the metabolic syndrome and resulting to nonalcoholic steatohepatitis (NASH) are prime causes of hepatocellular carcinoma (HCC) in Western industrialized countries. The incidence of HCC in NASH-cirrhosis is lower than that of HCC occuring in HCV-related or alcoholic cirrhosis. Up to 20% of cases of alcohol-associated HCC may develop in pre-cirrhotic liver while HCC is also increasingly recognised in pre-cirrhotic NASH raising questions on appropriate surveillance measures for these patient populations. The recently described steatohepatitic subtype of HCC presents with higher frequency in NAFLD compared to alcoholic liver disease (ALD) patients. This review will mainly focus on histopathology and summarize current data on the epidemiology, pathogenesis, diagnosis and management of NAFLD- and ALD-related HCC.
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Calderaro J, Couchy G, Imbeaud S, Amaddeo G, Letouzé E, Blanc JF, Laurent C, Hajji Y, Azoulay D, Bioulac-Sage P, Nault JC, Zucman-Rossi J. Histological subtypes of hepatocellular carcinoma are related to gene mutations and molecular tumour classification. J Hepatol 2017; 67:727-738. [PMID: 28532995 DOI: 10.1016/j.jhep.2017.05.014] [Citation(s) in RCA: 459] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/10/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Our increasing understanding of hepatocellular carcinoma (HCC) biology holds promise for personalized care, however its translation into clinical practice requires a precise knowledge of its relationship to tumour phenotype. METHODS We aimed at investigating molecular-phenotypic correlations in a large series of HCC. To this purpose, 343 surgically resected HCC samples were investigated by pathological review, immunohistochemistry, gene expression profiling and sequencing. RESULTS CTNNB1 (40%) and TP53 (21%) mutations were mutually exclusive and defined two major groups of HCC characterized by distinct phenotypes. CTNNB1 mutated tumours were large (p=0.002), well-differentiated (p<0.001), cholestatic (p<0.001), with microtrabecular (p<0.001) and pseudoglandular (p<0.001) patterns and without inflammatory infiltrates (p<0.001). TP53 mutated tumours were poorly differentiated (p<0.001) with a compact pattern (p=0.02), multinucleated (p=0.01) and pleomorphic (p=0.02) cells and frequent vascular invasion (p=0.02). World Health Organization (WHO) classification of histological subtypes were also strongly related to molecular features. The scirrhous subtype was associated with TSC1/TSC2 mutations (p=0.005), epithelial-to-mesenchymal transition and a progenitor expression profile. The steatohepatitic subtype showed frequent IL-6/JAK/STAT activation without CTNNB1, TERT and TP53 pathway alterations (p=0.01). Pathological review identified a novel subtype, designated as "macrotrabecular-massive" associated with poor survival (p<0.001), high alpha-fetoprotein serum level (p=0.02), vascular invasion (p<0.001), TP53 mutations (p<0.001) and FGF19 amplifications (p=0.02), features also validated in The Cancer Genome Atlas (TCGA) data. Finally, integration of HCC pathological characteristics with its transcriptomic classification showed phenotypically distinct tumour subclasses closely related to G1-G6 subgroups. CONCLUSION HCC phenotypes are tightly associated with gene mutations and transcriptomic classification. These findings may help in translating our knowledge of HCC biology into clinical practice. Lay summary: HCC is a very heterogenous tumour, both at the pathological and molecular levels. We show here that HCC phenotype is tightly associated to its molecular alterations and underlying oncogenic pathways.
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Affiliation(s)
- Julien Calderaro
- Inserm, UMR-1162, Functional Genomics of Solid Tumors, Equipe Labellisée Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France; Assistance Publique-Hôpitaux de Paris, Department of Pathology, CHU Henri Mondor, Créteil, France; Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Gabrielle Couchy
- Inserm, UMR-1162, Functional Genomics of Solid Tumors, Equipe Labellisée Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France
| | - Sandrine Imbeaud
- Inserm, UMR-1162, Functional Genomics of Solid Tumors, Equipe Labellisée Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France
| | - Giuliana Amaddeo
- Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Assistance Publique-Hôpitaux de Paris, Department of Hepatology, CHU Henri Mondor, Créteil, France; Inserm U955, Team 18, Créteil, France
| | - Eric Letouzé
- Inserm, UMR-1162, Functional Genomics of Solid Tumors, Equipe Labellisée Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France
| | - Jean-Frédéric Blanc
- Department of Hepatogastroenterology and Digestive Oncology, CHU Bordeaux, Hôpital Haut-Lévêque, 33600 Pessac, France; Inserm UMR 1053, Université de Bordeaux, 33076 Bordeaux, France
| | - Christophe Laurent
- Department of Digestive and Endocrine Surgery, CHU-Hôpitaux de Bordeaux, France
| | - Yacine Hajji
- Inserm, UMR-1162, Functional Genomics of Solid Tumors, Equipe Labellisée Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France
| | - Daniel Azoulay
- Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, 94000 Créteil, France
| | - Paulette Bioulac-Sage
- Inserm UMR 1053, Université de Bordeaux, 33076 Bordeaux, France; Department of Pathology, Pellegrin Hospital, CHU Bordeaux, Bordeaux 33076, France
| | - Jean-Charles Nault
- Inserm, UMR-1162, Functional Genomics of Solid Tumors, Equipe Labellisée Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France; Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
| | - Jessica Zucman-Rossi
- Inserm, UMR-1162, Functional Genomics of Solid Tumors, Equipe Labellisée Ligue Contre le Cancer, Université Paris Descartes, Université Paris Diderot, Université Paris 13, F-75010, France; Assistance Publique-Hôpitaux de Paris, Department of Oncology, Hôpital Européen Georges Pompidou, Paris, France.
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Abstract
Hepatocellular carcinomas can be further divided into distinct subtypes that provide important clinical information and biological insights. These subtypes are distinct from growth patterns and are on based on morphologic and molecular findings. There are 12 reasonably well-defined subtypes as well as 6 provisional subtypes, together making up 35% of all hepatocellular carcinomas. These subtypes are discussed, with an emphasis on their definitions and the key morphologic findings.
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Affiliation(s)
- Michael S Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA.
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Lee JS, Yoo JE, Kim H, Rhee H, Koh MJ, Nahm JH, Choi JS, Lee KH, Park YN. Tumor stroma with senescence-associated secretory phenotype in steatohepatitic hepatocellular carcinoma. PLoS One 2017; 12:e0171922. [PMID: 28273155 PMCID: PMC5342190 DOI: 10.1371/journal.pone.0171922] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/12/2016] [Indexed: 02/07/2023] Open
Abstract
Senescence secretome was recently reported to promote liver cancer in an obese mouse model. Steatohepatitic hepatocellular carcinoma (SH-HCC), a new variant of HCC, has been found in metabolic syndrome patients, and pericellular fibrosis, a characteristic feature of SH-HCC, suggests that alteration of the tumor stroma might play an important role in SH-HCC development. Clinicopathological characteristics and tumor stroma showing senescence and senescence-associated secretory phenotype (SASP) were investigated in 21 SH-HCCs and 34 conventional HCCs (C-HCCs). The expression of α-smooth muscle actin (α-SMA), p21Waf1/Cif1, γ-H2AX, and IL-6 was investigated by immunohistochemistry or immunofluorescence. SH-HCCs were associated with older age, higher body mass index, and a higher incidence of metabolic syndrome, compared to C-HCC (P <0.05, all). The numbers of α-SMA-positive cancer-associated fibroblasts (CAFs) (P = 0.049) and α-SMA-positive CAFs co-expressing p21Waf1/Cif1 (P = 0.038), γ-H2AX (P = 0.065), and IL-6 (P = 0.048) were greater for SH-HCCs than C-HCCs. Additionally, non-tumoral liver from SH-HCCs showed a higher incidence of non-alcoholic fatty liver disease and a higher number of α-SMA-positive stellate cells expressing γ-H2AX and p21Waf1/Cif1 than that from C-HCCs (P <0.05, all). In conclusion, SH-HCCs are considered to occur more frequently in metabolic syndrome patients. Therein, senescent and damaged CAFs, as well as non-tumoral stellate cells, expressing SASP including IL-6 may contribute to the development of SH-HCC.
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Affiliation(s)
- Jee San Lee
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
- BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Yoo
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyungjin Rhee
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
- BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myoung Ju Koh
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hae Nahm
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee-Ho Lee
- Division of Radiation Cancer Research, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
- BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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56
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Akai H, Kiryu S, Ohta Y, Yasaka K, Nakano Y, Inoue Y, Ohtomo K. The natural history of streptozotocin-stimulated non-alcoholic steatohepatitis mice followed by Gd-EOB-DTPA-enhanced MRI: Comparison with simple steatosis mice. Magn Reson Imaging 2017; 38:123-128. [PMID: 28062263 DOI: 10.1016/j.mri.2016.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE To clarify the development of HCC, temporal change of steatosis and Gd-EOB-DTPA enhancement of non-alcoholic steatohepatitis (NASH) model mice by magnetic resonance imaging (MRI). MATERIALS AND METHODS All animal experiments were approved by the institution's Animal Research Committee. MRI was performed on six NASH and six simple steatosis (SS) model mice every 2weeks from the ages of 8weeks to 16weeks. The sequential changes in the number and size of the focal liver lesions detected on Gd-EOB-DTPA-enhanced MRI were evaluated. Additionally, the hepatic fat fraction (HFF), contrast-to-noise ratio (CNR) and relative enhancement (RE) were calculated at each time point. The temporal changes and correlations in these parameters were evaluated. RESULTS All alive NASH model mice demonstrated focal liver lesions from week 10, at the latest. Number of the lesions increased with time, and all the lesion enlarged with time. All the lesions larger than 1mm were confirmed as hepatocellular carcinoma (HCC) pathologically. While the HFF remained constant in NASH model mice, HFF in SS model mice dramatically increased with time. CNR of the NASH model mice remained constant through the study period, while CNR in SS model mice decreased with time. Although no correlation was seen in NASH model mice, the HFF showed a negative correlation against CNR and RE in SS model mice. CONCLUSION Development of HCC was observed using Gd-EOB-DTPA-enhanced MRI only in NASH model mice. Degree of steatosis and hepatic enhancement by Gd-EOB-DTPA was both constant in NASH model mice, while steatosis increased and hepatic enhancement decreased with time in SS model mice.
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Affiliation(s)
- Hiroyuki Akai
- Department of Radiology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Shigeru Kiryu
- Department of Radiology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.
| | - Yasunori Ohta
- Department of Pathology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Koichiro Yasaka
- Department of Radiology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Yoshiyasu Nakano
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yusuke Inoue
- Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignant neoplasm in adults. Clinically, it tends to present late, and its prognosis historically has been poor, due to limited treatment options at the more advanced stage. A multidisciplinary approach for surveillance and early diagnosis of hepatocellular carcinoma in high-risk populations, combined with advances in surgical and other forms of ablative or chemotherapy, has greatly improved outcomes for patients with this tumor. Liver biopsies for HCC are becoming rare, being performed only for lesions that are atypical on imaging, to avoid the risk of bleeding or of inadvertently seeding the needle tract with HCC. HCC, a tumor of varied appearance, can be diagnostically challenging, particularly on a liver biopsy, due to sampling errors. Although HCC typically occurs on a background of cirrhosis, or advanced fibrosis, it may also arise in the noncirrhotic liver. Well-differentiated HCC may be hard to distinguish from benign lesions in the noncirrhotic liver and premalignant lesions in the cirrhotic liver, whereas a poorly-differentiated neoplasm may be difficult to tell apart from metastases or primary intrahepatic cholangiocarcinoma. Additionally, variant forms of HCC may mimic other neoplasms. This case-based review discusses typical HCC, the increasingly recognized steatohepatitic variant of HCC, the rare scirrhous variant of HCC and the extremely rare and clinically challenging cirrhotomimetic HCC.
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Affiliation(s)
- Rashmi M Agni
- Department of Pathology and Laboratory Medicine School of Medicine and Public Health University of Wisconsin - Madison UWHC Surgical Pathology Rm A4/204 - 3224 600 Highland Ave, Madison, WI 53792, United States.
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58
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Chan AWH, Yu S, Yu YH, Tong JHM, Wang L, Tin EKY, Chong CCN, Chan SL, Wong GLH, Wong VWS, Chan HLY, Lai PBS, To KF. Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse. Histopathology 2016; 69:971-984. [DOI: 10.1111/his.13029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/02/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Anthony W H Chan
- Department of Anatomical and Cellular Pathology; State Key Laboratory in Oncology in South China; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Shuangni Yu
- Department of Pathology; Peking Union Medical College Hospital; Beijing China
| | - Yau-Hei Yu
- Department of Anatomical and Cellular Pathology; State Key Laboratory in Oncology in South China; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Joanna H M Tong
- Department of Anatomical and Cellular Pathology; State Key Laboratory in Oncology in South China; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
- Institute of Digestive Disease; Partner State Key Laboratory of Digestive Disease; The Chinese University of Hong Kong; Hong Kong
- Li Ka Shing Institute of Health Science; Sir Y. K. Pao Cancer Center; The Chinese University of Hong Kong; Hong Kong
| | - Lei Wang
- Department of Pathology; Fudan University Shanghai Cancer Center; Shanghai China
- Department of Oncology; Shanghai Medical College; Fudan University; Shanghai China
| | - Edith K Y Tin
- Department of Anatomical and Cellular Pathology; State Key Laboratory in Oncology in South China; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Charing C N Chong
- Division of Hepatobiliary and Pancreatic Surgery; Department of Surgery; The Chinese University of Hong Kong; Hong Kong
| | - Stephen L Chan
- Institute of Digestive Disease; Partner State Key Laboratory of Digestive Disease; The Chinese University of Hong Kong; Hong Kong
- Department of Clinical Oncology; State Key Laboratory in Oncology in South China; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Grace L H Wong
- Institute of Digestive Disease; Partner State Key Laboratory of Digestive Disease; The Chinese University of Hong Kong; Hong Kong
- Department of Medicine and Therapeutics; The Chinese University of Hong Kong; Hong Kong
| | - Vincent W S Wong
- Institute of Digestive Disease; Partner State Key Laboratory of Digestive Disease; The Chinese University of Hong Kong; Hong Kong
- Department of Medicine and Therapeutics; The Chinese University of Hong Kong; Hong Kong
| | - Henry L Y Chan
- Institute of Digestive Disease; Partner State Key Laboratory of Digestive Disease; The Chinese University of Hong Kong; Hong Kong
- Department of Medicine and Therapeutics; The Chinese University of Hong Kong; Hong Kong
| | - Paul B S Lai
- Institute of Digestive Disease; Partner State Key Laboratory of Digestive Disease; The Chinese University of Hong Kong; Hong Kong
- Division of Hepatobiliary and Pancreatic Surgery; Department of Surgery; The Chinese University of Hong Kong; Hong Kong
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology; State Key Laboratory in Oncology in South China; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
- Institute of Digestive Disease; Partner State Key Laboratory of Digestive Disease; The Chinese University of Hong Kong; Hong Kong
- Li Ka Shing Institute of Health Science; Sir Y. K. Pao Cancer Center; The Chinese University of Hong Kong; Hong Kong
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Distinctive features of hepatocellular carcinoma in non-alcoholic fatty liver disease. Lancet Gastroenterol Hepatol 2016; 1:156-164. [PMID: 28404072 DOI: 10.1016/s2468-1253(16)30018-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma is the fifth most common cancer and the second leading cause of cancer-related death worldwide. Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis have been identified as emergent risk factors for this primary liver cancer. Incidence of NAFLD is increasing as a consequence of the epidemic spread of metabolic syndrome, which can result in progressive liver disease, leading to cirrhosis and its complications. Most data about the prevalence and incidence of hepatocellular carcinoma in patients with NAFLD are from a few population and cohort studies; its incidence is increasing and it is likely to become a leading indication for liver transplantation, especially in industrialised countries. In patients with NAFLD, hepatocellular carcinoma can arise in the context of non-cirrhotic liver, suggesting a specific carcinogenic pathway. Pathology studies have also described steatohepatitic hepatocellular carcinoma as a specific histological variant. NAFLD is underdiagnosed as causative liver disease, and patients are often diagnosed with hepatocellular carcinoma in the advanced stage because of the absence of efficient surveillance policies in this patient population. Management of hepatocellular carcinoma in patients with NAFLD is also complicated by comorbidities, mainly cardiac disease and diabetes, which negatively affect eligibility for radical treatments, including hepatic resection and, especially, liver transplantation. Finally, the effect of hepatocellular carcinoma treatments on postoperative morbidity, mortality, and disease-free survival remains to be precisely defined.
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Hepatocellular carcinoma in noncirrhotic livers is associated with steatosis rather than steatohepatitis: potential implications for pathogenesis. Eur J Gastroenterol Hepatol 2016; 28:955-62. [PMID: 27196679 DOI: 10.1097/meg.0000000000000641] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The risk of hepatocellular carcinoma (HCC) is increased in patients with metabolic syndrome (MS), possibly related to nonalcoholic fatty liver disease (NAFLD). As histological features of NAFLD may regress in cirrhosis, we compared steatosis versus steatohepatitis in the nontumoral liver of noncirrhotic HCC patients. PATIENTS AND METHODS A retrospective clinicopathological analysis was carried out in 91 noncirrhotic HCC patients. Patients were divided into three subgroups: that is, patients with: (1) MS without other risk factors for underlying liver disease, (2) no underlying risk factors, or (3) other risk factors (with or without MS). The NAFLD activity score (NAS) less than 3 was classified as no steatohepatitis, NAS 3-4 as borderline steatohepatitis, and NAS 5 or more as definite steatohepatitis. RESULTS Eleven (12%) patients had MS without other risk factors (group 1). In the nontumoral liver, significant steatosis (≥5% of hepatocytes) was generally present (in 10/11 patients), with mild lobular inflammation and absence of ballooning in most cases. Absence of steatohepatitis, borderline steatohepatitis, and definite steatohepatitis were found in 55, 45, and 0% of cases, respectively. In groups 2 and 3, significant steatosis was frequently present (in 16/37 and 21/43 patients, respectively). Absence of steatohepatitis, borderline steatohepatitis, and definite steatohepatitis were found in 84, 16, and 0% of cases (group 2), respectively, in 77, 23, and 0% of cases (group 3). CONCLUSION In noncirrhotic HCC patients, histological steatosis was frequently present, whereas overt steatohepatitis did not occur. These findings may be relevant for HCC pathogenesis in NAFLD.
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Goossens N, Hoshida Y. Is Hepatocellular Cancer the Same Disease in Alcoholic and Nonalcoholic Fatty Liver Diseases? Gastroenterology 2016; 150:1710-7. [PMID: 26784140 PMCID: PMC5120760 DOI: 10.1053/j.gastro.2016.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/03/2016] [Accepted: 01/07/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Nicolas Goossens
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA,Division of Gastroenterology and Hepatology, Geneva University Hospital, Geneva, Switzerland
| | - Yujin Hoshida
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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62
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Tan PS, Nakagawa S, Goossens N, Venkatesh A, Huang T, Ward SC, Sun X, Song WM, Koh A, Canasto-Chibuque C, Deshmukh M, Nair V, Mahajan M, Zhang B, Fiel MI, Kobayashi M, Kumada H, Hoshida Y. Clinicopathological indices to predict hepatocellular carcinoma molecular classification. Liver Int 2016; 36:108-18. [PMID: 26058462 PMCID: PMC4674393 DOI: 10.1111/liv.12889] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/01/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) is the second most lethal cancer caused by lack of effective therapies. Although promising, HCC molecular classification, which enriches potential responders to specific therapies, has not yet been assessed in clinical trials of anti-HCC drugs. We aimed to overcome these challenges by developing clinicopathological surrogate indices of HCC molecular classification. METHODS Hepatocellular carcinoma classification defined in our previous transcriptome meta-analysis (S1, S2 and S3 subclasses) was implemented in an FDA-approved diagnostic platform (Elements assay, NanoString). Ninety-six HCC tumours (training set) were assayed to develop molecular subclass-predictive indices based on clinicopathological features, which were independently validated in 99 HCC tumours (validation set). Molecular deregulations associated with the histopathological features were determined by pathway analysis. Sample sizes for HCC clinical trials enriched with specific molecular subclasses were determined. RESULTS Hepatocellular carcinoma subclass-predictive indices were steatohepatitic (SH)-HCC variant and immune cell infiltrate for S1 subclass, macrotrabecular/compact pattern, lack of pseudoglandular pattern, and high serum alpha-foetoprotein (>400 ng/ml) for S2 subclass, and microtrabecular pattern, lack of SH-HCC and clear cell variants, and lower histological grade for S3 subclass. Macrotrabecular/compact pattern, a predictor of S2 subclass, was associated with the activation of therapeutically targetable oncogene YAP and stemness markers EPCAM/KRT19. BMP4 was associated with pseudoglandular pattern. Subclass-predictive indices-based patient enrichment reduced clinical trial sample sizes from 121, 184 and 53 to 30, 43 and 22 for S1, S2 and S3 subclass-targeting therapies respectively. CONCLUSIONS Hepatocellular carcinoma molecular subclasses can be enriched by clinicopathological indices tightly associated with deregulation of therapeutically targetable molecular pathways.
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Affiliation(s)
- Poh Seng Tan
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S,Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore
| | - Shigeki Nakagawa
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Nicolas Goossens
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S,Division of Gastroenterology and Hepatology, Geneva University Hospital, Switzerland
| | - Anu Venkatesh
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Tiangui Huang
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Stephen C. Ward
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Xiaochen Sun
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Won-Min Song
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Anna Koh
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Claudia Canasto-Chibuque
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Manjeet Deshmukh
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Venugopalan Nair
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Milind Mahajan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Bin Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, U.S
| | - Maria Isabel Fiel
- Division of Gastroenterology and Hepatology, Geneva University Hospital, Switzerland
| | | | | | - Yujin Hoshida
- Division of Liver Diseases, Department of Medicine, Liver Cancer Program, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, U.S
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63
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β-catenin alteration is rare in hepatocellular carcinoma with steatohepatitic features: immunohistochemical and mutational study. Virchows Arch 2015; 467:535-42. [PMID: 26311355 DOI: 10.1007/s00428-015-1836-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/29/2015] [Accepted: 08/13/2015] [Indexed: 12/22/2022]
Abstract
Hepatocellular carcinoma (HCC) with steatohepatitic features (steatohepatitic HCC, SH-HCC) is a histological subset of HCC, highly associated with metabolic disease and underlying steatohepatitis. Although it has distinct clinicopathologic characteristics, little is known about the immunophenotype or genetic characteristics of SH-HCC. We conducted an immunohistochemical analysis on a tissue microarray containing 197 HCCs (70 SH-HCCs and 127 conventional HCCs (C-HCCs)), focusing on proteins associated with genetic subtypes of HCC and those associated with non-alcoholic fatty liver disease (NAFLD) or NAFLD-associated HCC. We also investigated CTNNB1 mutations in 84 HCCs (31 SH-HCCs and 53 C-HCCs) to better characterize the SH-HCC. When compared to C-HCC, SH-HCC was characterized by a significantly lower incidence of nuclear accumulation of β-catenin (5.7 vs. 25.2 %, p < 0.001) and by a lower incidence of overexpression (H-score = 300) of glutamine synthetase (4.3 vs. 26.0 %, p < 0.001). Multivariate logistic regression analysis revealed that the low rate of nuclear β-catenin accumulation in SH-HCC was independent of background etiology, including underlying steatohepatitis (p < 0.001). In accordance with the immunohistochemical results, CTNNB1 mutations were less frequent in SH-HCC than C-HCC (3.1 vs. 20.8 %, p < 0.048). Other notable findings included the ubiquitous expression of sonic hedgehog ligand in typical SH-HCC (100 %) and the less frequent expression of progenitor markers, such as SALL4 and EpCAM, in SH-HCC. These results indicate that SH-HCC as a subtype is not only characterized by morphology but also by distinct phenotypic and genetic traits.
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64
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Steatohepatitic variant of hepatocellular carcinoma in the absence of metabolic syndrome or background steatosis: a clinical, pathological, and genetic study. Hum Pathol 2015; 46:1769-75. [PMID: 26410018 DOI: 10.1016/j.humpath.2015.07.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 02/07/2023]
Abstract
Association between the steatohepatitic hepatocellular carcinoma (SH-HCC) and metabolic syndrome has been suggested. Most SH-HCC morphology appears to result from a typical HCC that retains the ability to respond to the metabolic syndrome and develops features of steatohepatitis. We aim to ask if this is true for all SH-HCC cases, or does the SH-HCC morphology in some cases reflect genetic changes inherent to the HCC itself, as opposed to wide tissue response in liver to the metabolic syndrome. Twelve SH-HCC cases occurring in individuals without metabolic syndrome were identified and examined pathologically. Genomic microarray analysis was performed in a subset. The SH-HCC in all cases showed diffuse moderate to marked fatty change, abundant balloon cells often containing Mallory-Denk bodies, and pericellular fibrosis. The background livers showed no significant fatty change in any cases. The background livers showed cirrhosis in seven cases and had no fibrosis in five cases. The underlying liver diseases were hepatitis C (n = 4) and no known (n = 8). The clinical and pathological characteristics of these cases did not differ significantly from the cases with the classical HCC morphology. Loss of 9q12-q31.1 was observed in a subset of cases, a finding that has not been previously reported in HCC. Our results indicate HCC can also develop steatohepatitic morphology outside the setting of fatty liver disease or metabolic syndrome. This SH-HCC is more likely to result from genetic changes to shared genes or metabolic pathways within the tumor and is an ideal subtype for future genetic studies. In this regard, potential genetic alterations include loss of 9q12-q31.1.
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Bringhenti I, Ornellas F, Martins MA, Mandarim-de-Lacerda CA, Aguila MB. Early hepatic insult in the offspring of obese maternal mice. Nutr Res 2014; 35:136-45. [PMID: 25582085 DOI: 10.1016/j.nutres.2014.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 12/17/2022]
Abstract
We hypothesized that the maternal obesity initiates metabolic disorders associated with oxidative stress in the liver of offspring since early life. Mouse's mothers were assigned into 2 groups according to the diet offered (n = 10 per group): standard chow (SC) or high-fat diet (HF). The results revealed that HF offspring had an increase in body mass at day 10 (+25%, P < .05) and in glucose levels (+25%, P < .0001). Hepatic triacylglycerol was increased in HF offspring at day 1 and day 10 compared with SC offspring (+30%, P < .01 and +40%, P < .01) as was hepatic steatosis (+110%, P < .001; +145%, P < .0001). Fatty acid synthase was increased in HF offspring at day 1 (+450%, P < .01) and peroxisome proliferator activator receptor-γ was elevated at day 1 and day 10 (+140%, P < .01; +2741%, P < .01). Peroxisome proliferator activator receptor-α was diminished in HF offspring at day 10 compared with SC offspring (-100%, P < .01). Moreover, carnitine palmitoyl-CoA transferase-1 was decreased in HF offspring at day 1 and day 10 (-80%, P < .01; -60%, P < .05). In the HF offspring (compared with the SC offspring), the catalase and the superoxide dismutase were significantly lower in both days 1 and 10 (P < .05). In 10-day-old offspring, glutathione peroxidase 1 and glutathione reductase were lower in HF offspring than in SC offspring (P < .0001). Our findings suggest that the maternal obesity in mice induces an early oxidative dysfunction coupled with hepatic steatosis and might contribute to progressive liver injury later in life.
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Affiliation(s)
- Isabele Bringhenti
- Laboratory of Morphometry, Metabolism and Cardiovascular Disease, Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Ornellas
- Laboratory of Morphometry, Metabolism and Cardiovascular Disease, Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcela Anjos Martins
- Laboratory of Morphometry, Metabolism and Cardiovascular Disease, Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Alberto Mandarim-de-Lacerda
- Laboratory of Morphometry, Metabolism and Cardiovascular Disease, Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Barbosa Aguila
- Laboratory of Morphometry, Metabolism and Cardiovascular Disease, Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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66
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Jain D. Steatohepatitic hepatocellular carcinoma: a metabolic syndrome-associated carcinoma. Histopathology 2014; 67:267. [DOI: 10.1111/his.12479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Deepali Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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