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Liao Z, Tang C, Luo R, Gu X, Zhou J, Gao J. Current Concepts of Precancerous Lesions of Hepatocellular Carcinoma: Recent Progress in Diagnosis. Diagnostics (Basel) 2023; 13:diagnostics13071211. [PMID: 37046429 PMCID: PMC10093043 DOI: 10.3390/diagnostics13071211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
The most common cause of hepatocellular carcinoma (HCC) is chronic hepatitis and cirrhosis. It is proposed that precancerous lesions of HCC include all stages of the disease, from dysplastic foci (DF), and dysplastic nodule (DN), to early HCC (eHCC) and progressed HCC (pHCC), which is a complex multi-step process. Accurately identifying precancerous hepatocellular lesions can significantly impact the early detection and treatment of HCC. The changes in high-grade dysplastic nodules (HGDN) were similar to those seen in HCC, and the risk of malignant transformation significantly increased. Nevertheless, it is challenging to diagnose precancerous lesions of HCC. We integrated the literature and combined imaging, pathology, laboratory, and other relevant examinations to improve the accuracy of the diagnosis of precancerous lesions.
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Affiliation(s)
- Ziyue Liao
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Cuiping Tang
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Rui Luo
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Xiling Gu
- Department of Pathology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Jun Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
| | - Jian Gao
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing 400010, China
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Yoon S, Shin B, Woo HG. Endoplasmic Reticulum Stress Induces CAP2 Expression Promoting Epithelial-Mesenchymal Transition in Liver Cancer Cells. Mol Cells 2021; 44:569-579. [PMID: 34294609 PMCID: PMC8424138 DOI: 10.14348/molcells.2021.0031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022] Open
Abstract
Cyclase-associated protein 2 (CAP2) has been addressed as a candidate biomarker in various cancer types. Previously, we have shown that CAP2 is expressed during multi-step hepatocarcinogenesis; however, its underlying mechanisms in liver cancer cells are not fully elucidated yet. Here, we demonstrated that endoplasmic reticulum (ER) stress induced CAP2 expression, and which promoted migration and invasion of liver cancer cells. We also found that the ER stress-induced CAP2 expression is mediated through activation of protein kinase C epsilon (PKCε) and the promotor binding of activating transcription factor 2 (ATF2). In addition, we further demonstrated that CAP2 expression promoted epithelial-mesenchymal transition (EMT) through activation of Rac1 and ERK. In conclusion, we suggest that ER stress induces CAP2 expression promoting EMT in liver cancers cells. Our results shed light on the novel functions of CAP2 in the metastatic process of liver cancer cells.
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Affiliation(s)
- Sarah Yoon
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea
- Department of Biomedical Science, Graduate School, Ajou University, Suwon 16499, Korea
| | - Boram Shin
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea
- Department of Biomedical Science, Graduate School, Ajou University, Suwon 16499, Korea
| | - Hyun Goo Woo
- Department of Physiology, Ajou University School of Medicine, Suwon 16499, Korea
- Department of Biomedical Science, Graduate School, Ajou University, Suwon 16499, Korea
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Ueno A, Masugi Y, Yamazaki K, Kurebayashi Y, Tsujikawa H, Effendi K, Ojima H, Sakamoto M. Precision pathology analysis of the development and progression of hepatocellular carcinoma: Implication for precision diagnosis of hepatocellular carcinoma. Pathol Int 2020; 70:140-154. [PMID: 31908112 DOI: 10.1111/pin.12895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/11/2019] [Indexed: 12/25/2022]
Abstract
Outcomes for patients with hepatocellular carcinoma (HCC) remain poor because the condition is often unresponsive to the available treatments. Consequently, the early and precise diagnosis of HCC is crucial to achieve improvements in prognosis. For patients with chronic liver disease, the assessment of liver fibrosis is also important to ascertain both the staging of fibrosis and the risk of HCC occurrence. Early HCC was first described in 1991 in Japan and was defined internationally in 2009. As the concept of early HCC spread, the multistage hepatocarcinogenesis process became accepted. Consequently, improvements in imaging technology made the early diagnosis of HCC possible. At present, the most appropriate therapeutic strategy for HCC is determined using an integrated staging system that assesses the tumor burden, the degree of liver dysfunction and the patient performance status; however, pathological and molecular features are not taken into account. The recent introduction of several new therapeutic agents will change the treatment strategy for HCC. Against this background, HCC subclassification based on tumor cellular and microenvironmental characteristics will become increasingly important. In this review, we give an overview of how pathological analysis contributes to understanding the development and progression of HCC and establishing a precision diagnosis of HCC.
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Affiliation(s)
- Akihisa Ueno
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Ken Yamazaki
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Kurebayashi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hanako Tsujikawa
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Kathryn Effendi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hidenori Ojima
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
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Low HM, Choi JY, Tan CH. Pathological variants of hepatocellular carcinoma on MRI: emphasis on histopathologic correlation. Abdom Radiol (NY) 2019; 44:493-508. [PMID: 30145629 DOI: 10.1007/s00261-018-1749-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hepatocellular carcinoma (HCC) is a unique tumor because it is one of the few cancers which can be treated based on imaging alone. Magnetic resonance imaging (MRI) carries higher sensitivity and specificity for the diagnosis of HCC than either computed tomography (CT) or ultrasound. MRI is imaging modality of choice for the evaluation of complex liver lesions and HCC because of its inherent ability to depict cellularity, fat, and hepatocyte composition with high soft tissue contrast. The imaging features of progressed HCC are well described. However, many HCC tumors do not demonstrate classical imaging features, posing a diagnostic dilemma to radiologists. Some of these can be attributed to variations in tumor biology and histology, which result in radiological features that differ from the typical progressed HCC. This pictorial review seeks to demonstrate the appearance of different variants of HCC on MRI imaging, in relation to their histopathologic features.
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Affiliation(s)
- Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Jin Young Choi
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Lee Kong Chian School of Medicine, 11, Mandalay Road, Singapore, 308232, Singapore.
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Yagi T, Nakanuma Y, Sato Y, Nitta T, Sasaki M, Gabata T, Harada K. The clinicopathological characterization of small hepatocellular carcinoma with fibrous stroma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:4806-4816. [PMID: 31949555 PMCID: PMC6962937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/28/2018] [Indexed: 06/10/2023]
Abstract
Recent studies emphasized the significance of fibrous stroma affecting tumor biology in hepatocellular carcinoma (HCC). To further clarify fibrous stroma's significance, this study investigated the clinicopathological characteristics of HCC with fibrous stroma. A total of 214 nodules of HCC smaller than 3 cm in diameter were analyzed, and 22 (10%) were regarded as HCC with fibrous stroma. Most cases of HCC with fibrous stroma were the simple nodular type without a fibrous capsule, and histologically well- or moderately-differentiated. A subset of the scirrhous variant of HCC was included in this category, and steatohepatitic features, such as Mallory-Denk body formation and lymphoid infiltrates, were also frequently found. Foci with a histological appearance corresponding to dysplastic nodules and/or early HCC were rarely observed in HCC with fibrous stroma, suggesting that some cases occurred via a de novo carcinogenic process. The immunohistochemical expression of cytokeratin 7 and the epithelial cell adhesion molecule was more significantly increased in HCC with fibrous stroma than in conventional HCC. Furthermore, the expression of C reactive protein and serum amyloid A, indicative of the activation of the IL-6/STAT pathway, was increased in HCC with fibrous stroma. Radiologically, HCC with fibrous stroma exhibited hyperdense nodules on computed tomography and did not show a nodule-in-nodule appearance. Overall survival and disease-free survival were not significantly different between cases of HCC with fibrous stroma and conventional HCC. This study elucidated the clinicopathological features of HCC with fibrous stroma, which may represent a biologically different process occurring in HCC.
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Affiliation(s)
- Toshihiro Yagi
- Department of Human Pathology, Kanazawa University Graduate School of MedicineKanazawa, Japan
- Department of Radiology, Kanazawa University Graduate School of MedicineKanazawa, Japan
| | - Yasuni Nakanuma
- Department of Diagnostic Pathology, Fukui-ken Saiseikai HospitalFukui, Japan
| | - Yasunori Sato
- Department of Human Pathology, Kanazawa University Graduate School of MedicineKanazawa, Japan
| | - Takeo Nitta
- Department of Human Pathology, Kanazawa University Graduate School of MedicineKanazawa, Japan
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of MedicineSapporo, Japan
| | - Motoko Sasaki
- Department of Human Pathology, Kanazawa University Graduate School of MedicineKanazawa, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of MedicineKanazawa, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of MedicineKanazawa, Japan
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Hammam O, Magdy M, Anas A, Rahim AA, Heedaya M, Helmy A. Expression of hnRNPK & Claudin-4 in HCV-Induced Early HCC and Adjacent Liver Tissue. Open Access Maced J Med Sci 2017; 5:595-602. [PMID: 28932298 PMCID: PMC5591587 DOI: 10.3889/oamjms.2017.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 06/16/2017] [Accepted: 06/17/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: HCC in Egypt usually occurs in HCV cirrhotic livers with poor prognosis due to late diagnosis. High hnRNPK & low Claudin-4 profiles indicate Epithelial Mesenchymal Transition (EMT), malignant transformation and high-grade tumours. AIM: We studied the immunohistochemical expression of hnRNPK and Claudin-4 in HCV induced early HCC (eHCC) and adjacent liver tissue in Egyptian patients to improve eHCC detection in cirrhotic livers with better curative therapy options. METHOD: We studied the immunohistochemical expression of hnRNPK and Claudin-4 in 100 Egyptian patients resection specimens of HCV induced early HCC (eHCC) and adjacent liver tissue, in order to improve eHCC detection in cirrhotic livers, thus improving their therapeutic options. RESULTS: Early HCC grade significantly directly correlated with nuclear hnRNPK/5HPFs count and inversely correlated with Claudin-4 expression %, with a converse correlation between hnRNPK and Claudin-4. Moreover in eHCC, combined hnRNPK ≥ 30/5HPFs & Claudin-4 ≥ 40% significantly distinguished low grade eHCC (G1) from high grade eHCC (G2&G3), with sensitivity 97% & specificity 69.7% for hnRNPK ≥ 30/5HPFs, and with sensitivity 70% & specificity 94.3% for Claudin-4 ≥ 40%. Moreover in the adjacent liver, both markers expressions significantly directly correlated with each other and with METAVIR fibrosis score but not with activity. Furthermore, 58% of eHCCs showed hnRNPK ≥ 30 Claudin-4 < 40% profile, indicating EMT type 3, compared to 26% with hnRNPK ≥ 30 Claudin-4 ≤ 10% profile in adjacent cirrhotic/ precirrhotic liver, with significant use of combined hnRNPK ≥ 30/5HPFs & Claudin 4 ≤ 10% as eHCC prediction cut offs in cirrhosis (p < 0.05). CONCLUSION: Combination of hnRNPK and Claudin-4 can indicate early HCC development in HCV cirrhotic livers using hnRNPK ≥ 30/5HPFs & Claudin-4 ≤ 10% cut offs. Also, combination of hnRNPK ≥ 30/5HPFs & Claudin-4 ≥ 40% can distinguish low grade eHCC (G1) from high grade eHCC (G2&G3).
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Affiliation(s)
- Olfat Hammam
- Department of Pathology Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Egypt
| | - Mona Magdy
- Department of Pathology Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Egypt
| | - Amgad Anas
- Department of Hepato-gastroenterology, Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Egypt
| | - Ali Abdel Rahim
- Department of Hepato-gastroenterology, Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Egypt
| | - Mohamed Heedaya
- Department of General Surgery, Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Egypt
| | - Ahmed Helmy
- Department of General Surgery, Theodor Bilharz Research Institute (TBRI), Imbaba, Giza, Egypt
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Hytiroglou P. Well-differentiated hepatocellular nodule: Making a diagnosis on biopsy and resection specimens of patients with advanced stage chronic liver disease. Semin Diagn Pathol 2016; 34:138-145. [PMID: 28117103 DOI: 10.1053/j.semdp.2016.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Guided liver biopsy is commonly employed to determine the identity of distinct hepatic nodules detected on imaging studies of patients with advanced stage chronic liver diseases. Discrimination among large regenerative nodule, dysplastic nodule and well-differentiated hepatocellular carcinoma is often difficult and relies on subtle histologic findings. Sampling is an important consideration in biopsy material, as compared to resection specimens, because the diagnostic features may be focal within the nodule. Immunohistochemical stains may be useful in distinguishing between large regenerative and dysplastic nodule on the one hand, versus early and classic hepatocellular carcinoma on the other. Ongoing research on the early lesions of hepatocarcinogenesis is enhancing our understanding of the sequential steps of this process and provides novel tools for histopathologic differential diagnosis.
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Affiliation(s)
- Prodromos Hytiroglou
- Department of Pathology, Aristotle University School of Medicine, Thessaloniki 54006, Greece.
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Ojima H, Masugi Y, Tsujikawa H, Emoto K, Fujii-Nishimura Y, Hatano M, Kawaida M, Itano O, Kitagawa Y, Sakamoto M. Early hepatocellular carcinoma with high-grade atypia in small vaguely nodular lesions. Cancer Sci 2016; 107:543-50. [PMID: 26797961 PMCID: PMC4832853 DOI: 10.1111/cas.12893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/31/2015] [Accepted: 01/14/2016] [Indexed: 01/13/2023] Open
Abstract
Multistep hepatocarcinogenesis progresses from dysplastic nodules to early hepatocellular carcinoma (eHCC) and to advanced HCC. The aim of the present study was to investigate the detailed histopathological features of eHCC. We investigated 66 small vaguely nodular lesions resected from 40 patients. The degree of cellular and structural atypia and stromal invasion were assessed. The immunohistochemical expression of HCC‐related markers adenylate cyclase‐associated protein 2 (CAP2), heat shock protein 70 (HSP70), Bmi‐1, CD34 and h‐caldesmon were evaluated. Of the 66 nodules, 10 were diagnosed as low‐grade dysplastic nodules (LGDN), 10 as high‐grade dysplastic nodules (HGDN) and 46 as eHCC. Among the 46 eHCC, 18 nodules (39.1%) showed marked stromal invasion and/or the presence of the scirrhous component and were subclassified as high‐grade eHCC (HGeHCC). The remaining 28 eHCC, which lacked these features, were subclassified as low‐grade eHCC (LGeHCC) and were examined further. HGeHCC showed high levels of cellular and structural atypia and large tumor size. The immunohistochemical expression of CAP2 and the area of sinusoidal vascularization showed increases from LGDN to HGeHCC. The density of arterial tumor vessels was high in HGeHCC compared with other nodule types. Cluster analysis of these parameters subclassified 65 nodules into HGeHCC‐dominant, LGeHCC and HGDN‐dominant, and LGDN‐dominant groups. These results indicate the increased malignant potential of HGeHCC and suggest that it is already a transitional stage to advanced HCC. We consider that our grading classification system may be valuable for considering treatment strategies for eHCC around 2 cm in diameter.
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Affiliation(s)
- Hidenori Ojima
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hanako Tsujikawa
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Katsura Emoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | | | - Mami Hatano
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Miho Kawaida
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Osamu Itano
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
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