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Akiba J, Nakayama M, Sadashima E, Kusano H, Kondo R, Mihara Y, Naito Y, Mizuochi S, Yano Y, Kinjo Y, Tsutsui K, Kondo K, Sakai H, Hisaka T, Nakashima O, Yano H. Prognostic impact of vessels encapsulating tumor clusters and macrotrabecular patterns in hepatocellular carcinoma. Pathol Res Pract 2022; 238:154084. [PMID: 36087415 DOI: 10.1016/j.prp.2022.154084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) shows a high mortality rate. A macrotrabecular (MT) pattern and vessels encapsulating tumor clusters (VETC) pattern have been reported as aggressive histological patterns in HCC. However, their cut-off values have been contentious. METHOD Nine hundred eighty-five cases of previously diagnosed HCC were enrolled. The percentage areas of the MT and/or VETC pattern with ≥ 5% at every 10% increment were assessed. Clinicopathological analysis including patients' prognosis was conducted. RESULT One hundred fifty-eight and eighty-four cases were accompanied by 5-49% and ≥ 50% MT components, respectively. Two hundred six and twenty-nine cases had 5-49% and ≥ 50% VETC components, respectively. Cases with these histological patterns in common had aggressive characteristics and worse prognosis compared to cases with none of these patterns. The presence of 5-49% VETC pattern was independent worse prognostic factor in overall survival (P = 0.046). HCCs with the MT pattern and the VETC pattern were significantly accompanied by the VETC pattern and the MT pattern (P < 0.001), respectively. CONCLUSION As even 5% of the MT pattern and/or VETC pattern affected the prognosis of patients with HCC, the amount of these pattern should be described in pathological reports. This information could be useful in expecting patients' prognosis and providing proper post-operative treatments.
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Affiliation(s)
- Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Masamichi Nakayama
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Eiji Sadashima
- Life Science Research Institute, Saga-ken Medical Centre Koseikan, Kase-machi, Oaza, Nakahara 400, Saga 840-8571, Japan.
| | - Hironori Kusano
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Reiichiro Kondo
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Yutaro Mihara
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Yoshiki Naito
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Shinji Mizuochi
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Yuta Yano
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Yoshinao Kinjo
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Kana Tsutsui
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Keiichi Kondo
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Hisamune Sakai
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Toru Hisaka
- Department of Surgery, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Osamu Nakashima
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Asahi-machi 67, Kurume 830-0011, Japan.
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume 830-0011, Japan.
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Rhee H, An C, Kim HY, Yoo JE, Park YN, Kim MJ. Hepatocellular Carcinoma with Irregular Rim-Like Arterial Phase Hyperenhancement: More Aggressive Pathologic Features. Liver Cancer 2019; 8:24-40. [PMID: 30815393 PMCID: PMC6388566 DOI: 10.1159/000488540] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/18/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS The purpose of our study was to examine the histopathologic characteristics of hepatocellular carcinoma (HCC) with irregular rim-like arterial phase enhancement (IRE), which has been reported to be associated with more aggressive tumor behavior. METHODS We investigated 84 pathologically confirmed HCCs in 84 patients who underwent curative hepatic resection after gadoxetate-enhanced magnetic resonance imaging between January 2008 and February 2013. Two abdominal radiologists independently reviewed these images and classified HCCs into two categories: HCC showing IRE (IRE-HCC) and HCC showing hypoenhancement or diffuse arterial enhancement (non-IRE-HCC). Twenty-two HCCs were classified as IRE-HCCs, and 51 were classified as non-IRE-HCCs concordantly by both reviewers. The remaining 11 HCCs, on whose radiologic classifications the reviewers disagreed, were classified as HCCs with intermediate enhancement patterns. The HCC clinicopathologic characteristics and patient outcomes were then compared. RESULTS IRE-HCCs showed more frequent microvascular invasion (91 vs. 35%), lower microvascular density (246.5 vs. 426.5/mm2), higher proportions of sinusoid-like microvascular pattern (55 vs. 0%) and macrotrabecular pattern (45 vs. 0%), and larger areas of tumor necrosis (15 vs. 0%) and fibrous stroma (8.3 vs. 2.1%) than non-IRE-HCCs. IRE-HCCs also expressed higher levels of immunomarkers of hypoxia (carbonic anhydrase IX, 64 vs. 8%) and stemness (EpCAM, 50 vs. 20%). p values were < 0.001 for all comparisons except for EpCAM (p = 0.026). HCCs with intermediate enhancement patterns showed mixed/intermediate pathologic features from both IRE- and non-IRE-HCCs. IRE-HCC patients showed poorer 5-year disease-free survival after curative resection than non-IRE-HCC patients (p = 0.005). CONCLUSIONS IRE-HCCs demonstrate aggressive histopathologic features, including more hypoxic and fibrotic tumor microenvironments and increased stemness, compared to non-IRE-HCCs. IRE might therefore serve as a noninvasive imaging biomarker for aggressive HCC.
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Affiliation(s)
- Hyungjin Rhee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chansik An
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye-Young Kim
- Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Yoo
- Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, Integrated Genomic Research Center for Metabolic Regulation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Nyun Park
- Department of Pathology, Brain Korea 21 PLUS Project for Medical Science, 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
| | - Myeong-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea,*Myeong-Jin Kim, MD, PhD, Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul 03722 (South Korea), E-Mail , Young Nyun Park, MD, PhD, Department of Pathology, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul 03722 (South Korea), E-Mail
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