Title: The stromal morphological changes for differential diagnosis of uninodular high-grade dysplastic nodule and well-differentiated small hepatocellular carcinoma
Abstract: // Long-Hai Feng 1, 2, 3, * , Han Wang 1, 2, 3, * , Hui Dong 1, 2, 3 , Yu-Yao Zhu 1, 2, 3 and Wen-Ming Cong 1, 2, 3 1 Department of Pathology, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Yangpu, Shanghai, 200438, China 2 Key Laboratory of Signaling Regulation and Targeting Therapy of Liver Cancer (Second Military Medical University) Ministry of Education, Yangpu, Shanghai, 200438, China 3 Shanghai Key Laboratory of Hepatobiliary Tumor Biology (Eastern Hepatobiliary Surgery Hospital ), Yangpu, Shanghai, 200438, China * Authors contributed equally to this work and serve as co-first authors Correspondence to: Wen-Ming Cong, email: [email protected] Keywords: HGDNs, WD-SHCCs, stromal changes, diagnosis, differential diagnosis Received: April 09, 2017 Accepted: August 17, 2017 Published: September 01, 2017 ABSTRACT Aim: The stromal invasion has been regarded as the most valuable clue to distinguish high-grade dysplastic nodules (HGDNs) and well-differentiated small hepatocellular carcinomas (WD-SHCCs). The purposes of this study are to explore the stromal morphological changes for the differential diagnosis of these two equivocal lesions. Results: Based on the systemic studies of histological characteristics of HGDNs and WD-SHCCs, the stromal morphological changes, including sinusoid capillarization, ductular reaction and solitary artery, were performed to make a differential diagnosis between them. Separately, the solitary artery had the best sensitivity (93.75%) and accuracy (88.89%), and the sinusoid capillarization had the best specificity of 90.32%. On the whole, when at least 2 stromal morphological changes were abnormal, no matter what combination, the diagnostic performance was favorable and optimal with the highest accuracy of 92.06%, balancing the sensitivity (93.75%) and specificity (90.32%). The diagnostic performances were prior to the classical immunohistochemical panel comprising heat shock protein 70, glypican 3 and glutamine synthetase with the best sensitivity, specificity and accuracy of 62.50%, 80.65% and 71.43%, respectively. Materials and Methods: A retrospective case-control study was conducted on 63 patients who underwent partial hepatectomy for uninodular HGDNs or WD-SHCCs at the Eastern Hepatobiliary Surgery Hospital from 2005 to 2015. Conclusions: The stromal morphological changes, containing sinusoid capillarization, ductular reaction and solitary artery could provide a more considerable diagnostic and differential diagnostic performance between HGDNs and WD-SHCCs. And they should be the key points during the histopathological diagnosis.