66-year-old female suffered from acute hepatitis B about 25 years ago. She now rapidly developed hepatomegaly.
- The liver parenchyma is mostly destroyed by a diffusely growing tumor exhibiting extensive necrosis. Only marginal areas of regular liver tissue with central veins and portal tracts are observed.
- The tumor cells grossly resemble hepatocytes. However, they exhibit distinct pleomorphism with marked variations in size and shape. The nuclei are enlarged, polymorphic, with prominent nucleoli. Many, in part atypical mitotic figures are observed.
- In most parts, tumor cells do not exhibit a defined growth pattern. Only few form ill-defined acini (acinar pattern), some of which contain bile plugs. The production of bile serves as a ‘tumor marker’ and proves the diagnosis of hepatocellular carcinoma (HCC).
Chronic hepatitis B and C infections, dietary aflatoxin B1 ingestion and chronic alcohol abuse are the most common etiological factors associated with HCC. Liver cirrhosis is the major clinical risk factor for the development of HCC independent of its original etiology. Indeed, in 70-90% of cases HCC develops in the setting of macronodular cirrhosis.