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Ductular reaction is helpful in defining early stromal invasion, small hepatocellular carcinomas, and dysplastic nodules
Author(s) -
Park Young Nyun,
Kojiro Masamichi,
Di Tommaso Luca,
Dhillon Amar P.,
Kondo Fukuo,
Nakano Masayuki,
Sakamoto Michiie,
Theise Neil D.,
Roncalli Massimo
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22460
Subject(s) - hccs , medicine , nodule (geology) , pathology , cytokeratin , hepatocellular carcinoma , biopsy , stromal cell , immunostaining , keratin 7 , immunohistochemistry , biology , paleontology
Abstract BACKGROUND. Stromal invasion is 1 of the main features used to distinguish high‐grade dysplastic nodules (DNs) from well‐differentiated hepatocellular carcinomas (HCCs). The authors hypothesized that ductular reaction (DR) takes place around noninvasive hepatocellular nodules but not within the stroma contiguous to invasive HCC. METHODS. DR/cytokeratin 7 (CK7)‐positive patterns were evaluated in 105 resected small hepatic nodules according to the level of invasion. The nodules were classified histologically prior to immunostaining as noninvasive (large regenerative nodules, low‐grade DNs, and high‐grade DNs), minimally invasive (early HCCs with a vaguely nodular type), and overtly invasive (typical HCCs with a distinctly nodular type) in a review by expert pathologists, the current gold standard. Intranodular DR (inner DR) and DR around the nodule periphery (outer DR) were assessed separately on a semiquantitative scale from 0 to 4+. RESULTS. DR was 3 or 4+ in the majority of noninvasive nodules (inner DR, 81%; outer DR, 91%), whereas DR was 0 or 1+ in overtly invasive HCCs (inner DR, 96%; outer DR, 81%). Minimally invasive HCCs showed an intermediate DR pattern (2 or 3+ inner DR, 75%; 2+ outer DR, 67%). DR characteristically was absent at the stromal‐invasive, leading edge of tumor cells in both minimally invasive HCCs (focal loss of DR/CK7) and overtly invasive HCCs (diffuse loss of DR/CK7). The DR patterns in 41 needle‐biopsy samples were similar to the patterns observed in resected nodules. CONCLUSIONS. DR/CK7 immunostaining may help to identify small foci of invasion and to distinguish noninvasive, high‐grade DNs from both minimally invasive and overtly invasive HCCs. Cancer 2007 © 2007 American Cancer Society.