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Liver and intrahepatic bile ducts - Tumor

Dysplasia

Borderline nodule


Reviewers: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 January 2013, last major update February 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.

General
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● Also called high grade dysplastic nodule, macroregenerative nodule type II, atypical macroregenerative nodule, atypical adenomatous hyperplasia, grade 1 hepatocellular carcinoma
● Much less common than macroregenerative nodule
● Present in 5-15% of cirrhotic livers or livers with mild scarring
● Usually 1 cm (or < 1.5cm); may be single or multiple
● Considered a precursor to hepatocellular carcinoma; usually increase in size over time and don’t regress
● 66% risk of hepatocellular carcinoma in liver explants, 100% risk at autopsy
● Biopsy may be best described as “uncertain malignant potential” because cannot exclude hepatocellular carcinoma without a complete resection

Treatment
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● Ablation or resection should be strongly considered

Gross description
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● Frequently multiple, may be single, coexists with macroregenerative nodule (which they grossly resemble), usually less than 2 cm

Micro description
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● Either dysplastic features in subpopulation of cells 1 mm or more or normal histology with evidence of clonality
● May be low grade or high grade; dysplastic features include small cell change (small size, reduced and more basophilic cytoplasm) or large cell change in more than random cells
● May have pseudoglands, moderate nuclear pleomorphism, rare mitotic figures, rare hepatic plates 3 cells wide
● No uniformly prominent nucleoli
● Often conspicuous intranodular arteries, portal tracts may be abnormal
● Few and scarred portal tracts seen
● Unpaired or nontriadal arteries are present
● Sinusoidal capillarization

Positive stains
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● Sinusoids positive for factor VIII and CD34

Differential diagnosis
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● Dysplastic focus (less than 1 mm)
● Hepatocellular carcinoma: denser nuclei per unit area excluding atrophic areas (2 x density of extranodular hepatocytes), irregular nuclear contour, invasion of stroma or portal tracts, mitotic figures, pseudoglands in the absence of cholestasis, disrupted reticulin framework, clonelike clear/fatty, iron or copper containing foci; GPC-3+, HSP-70+, Glutamine synthatase+ (Hepatology 2007;45:725); ductular reaction absent (CK7/CK19 negative)

End of Liver and intrahepatic bile ducts - Tumor > Dysplasia > Borderline nodule


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