Liver & intrahepatic bile ducts

Hepatocellular carcinoma

Steatohepatitic HCC


Editorial Board Member: Monika Vyas, M.D.
Deputy Editor-in-Chief: Raul S. Gonzalez, M.D.
Stephen C. Ward, M.D., Ph.D.

Topic Completed: 15 July 2021

Minor changes: 15 July 2021

Copyright: 2021, PathologyOutlines.com, Inc.

PubMed Search: Steatohepatitic HCC

Stephen C. Ward, M.D., Ph.D.
Page views in 2021 to date: 1,288
Cite this page: Ward SC. Steatohepatitic HCC. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/liversteatohepatiticHCC.html. Accessed December 8th, 2021.
Definition / general
  • WHO recognized histological variant of hepatocellular carcinoma (HCC) in which the tumor cells show histologic features resembling nonneoplastic steatohepatitis
  • This variant usually arises in the setting of steatohepatitis (Am J Surg Pathol 2010;34:1630)
Essential features
Terminology
  • Steatohepatic variant of hepatocellular carcinoma
ICD coding
  • No specific code for steatohepatitic HCC
Epidemiology
Sites
  • Liver
Pathophysiology
  • Similar to HCC
Etiology
Clinical features
Diagnosis
  • Similar to HCC
Laboratory
  • Similar to HCC
Radiology description
Prognostic factors
  • Similar prognosis to conventional HCC
Case reports
Treatment
  • Similar to HCC
Gross description
  • May show yellow cut surface
Gross images

Contributed by Stephen C. Ward, M.D., Ph.D.
Yellow cut surface

Yellow cut surface

Microscopic (histologic) description
  • Hepatocellular carcinoma with ≥ 50% of tumor showing 3 or more of the following steatohepatitis-like features (Am J Surg Pathol 2010;34:1630):
    • Steatosis
    • Hepatocyte ballooning
    • Mallory-Denk bodies
    • Inflammation
    • Pericellular fibrosis
Microscopic (histologic) images

Contributed by Stephen C. Ward, M.D., Ph.D.
Steatosis

Steatosis in tumor

Ballooning degeneration

Ballooning degeneration

Mallory-Denk bodies

Mallory-Denk bodies

Chronic inflammatory infiltrate

Chronic inflammatory infiltrate

Pericellular fibrosis

Pericellular fibrosis


Masson trichrome

Masson trichrome

Ubiquitin

Ubiquitin

Arginase1

Arginase1

HepPar1

HepPar1

Cytology description
Cytology images

Images hosted on other servers:

Atypical hepatocytes with steatototic vacuoles

Positive stains
Molecular / cytogenetics description
  • Associated with S1 molecular subclass (TGFβ pathway activation) (Liver Int 2016;36:108)
  • Associated with G4 subgroup (JAK / STAT pathway activation, lack of mutations in CTNNB1, TP53 and TERT promoter) (J Hepatol 2017;67:727)
Sample pathology report
  • Liver mass, needle biopsy:
    • Moderately differentiated hepatocellular carcinoma, steatohepatitic variant
Differential diagnosis
Additional references
Board review style question #1

This image is from a 4 cm liver lesion in a 65 year old man. What would be the most likely underlying liver disease in this patient?

  1. Acute hepatitis B
  2. Autoimmune hepatitis
  3. Chronic hepatitis C
  4. Primary biliary cholangitis
  5. Steatohepatitis
Board review style answer #1
E. Steatohepatitis. Steatohepatitic hepatocellular carcinoma most commonly arises in the setting of steatohepatitis, either alcoholic or nonalcoholic.

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Reference: Steatohepatitic HCC
Board review style question #2
Which of the following is true regarding staining of steatohepatitic hepatocellular carcinoma?

  1. Oil red O stain must be performed on formalin fixed paraffin embedded tissue
  2. PAS stain will show that the clear droplets contain dense glycogen
  3. Trichrome stain generally shows a thick fibrous capsule with minimal intratumoral fibrosis
  4. Ubiquitin stain can be used to highlight Mallory-Denk bodies
Board review style answer #2
D. Ubiquitin stain can be used to highlight Mallory-Denk bodies. Mallory-Denk bodies may not be present in all cases of steatohepatitic hepatocellular carcinoma but immunohistochemical stain for ubiquitin can be used to confirm or highlight their presence. The cytoplasmic vacuoles in steatohepatitic hepatocellular carcinoma contain predominantly lipid, not glycogen, so they would not be expected to stain with PAS. Oil red O and Sudan Black stains must be performed on frozen tissue (most fat is removed during tissue processing for paraffin embedding). Steatohepatitic hepatocellular carcinoma classically shows a pericellular fibrosis pattern.

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Reference: Steatohepatitic HCC
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