Elsevier

Clinics in Liver Disease

Volume 24, Issue 4, November 2020, Pages 591-610
Clinics in Liver Disease

Hepatocellular Carcinoma: Role of Pathology in the Era of Precision Medicine

https://doi.org/10.1016/j.cld.2020.07.010Get rights and content

Section snippets

Key points

  • Precise diagnosis of hepatocellular carcinoma (HCC) requires clinical, radiological, and histologic correlation.

  • Ancillary tests should be used cautiously while establishing a diagnosis of HCC.

  • Certain subtypes of HCC have molecular correlates that have an impact on prognosis and treatment.

Diagnosis of hepatocellular carcinoma

Knowledge of clinical and radiologic findings is paramount for the pathologist while making the diagnosis of HCC. Clinical information, especially age, is very helpful and can point to certain diagnoses. Presence of risk factors, such as metabolic disorders, nonalcoholic steatohepatitis (NASH), and viral hepatitis, increases the likelihood of detecting abnormality in the pathology specimen. Similarly, the importance of radiologic impression cannot be overemphasized. In many instances when the

Major hepatocellular carcinoma subtypes

Many architectural growth patterns and histologic subtypes of HCC have been recognized. It is important to identify the morphologic spectrum of HCC not only to enable accurate diagnosis but also for prognostication. Histologic subtypes should not be confused with architectural growth patterns. Although there are 4 major architectural growth patterns, there can be many histologic subtypes (Table 2). The 4 major architectural growth patterns include trabecular, solid/compact,

Morpho-molecular classification of hepatocellular carcinoma

The molecular classification of HCC has evolved dramatically over the past decade. The Cancer Genome Atlas Research Network results showed that TERT promoter, TP53 and CTNNB1 were seen in more than 70% of HCCs.97 This work was further advanced by the French classification group, which not only provided molecular classification groups but also introduced several morphologic categories based on histologic and molecular correlation.62 The HCCs were classified into 6 groups based on proliferative

Summary

Comprehensive molecular profiling of HCC has ushered a new era in the pathology of hepatocellular neoplasms. morpho-molecular correlation studies have enabled identification of histologic features associated with specific molecular alterations. The role of pathology has shifted from mere diagnosis to prediction of prognosis and response to targeted therapy. In addition to guiding the surgeon’s hand, pathology is now also guiding oncologists in treating patients in this era of precision

Disclosure

The authors have nothing to disclose.

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