Journal of Clinical Pathology and Laboratory Medicine

All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.
Reach Us +1 (202) 780-3397

Commentary - Journal of Clinical Pathology and Laboratory Medicine (2025) Volume 7, Issue 2

Anatomical pathology of hepatocellular carcinoma: A clinicopathologic review.

Michael Nguyen*

Department of Laboratory Medicine and Pathology, University of Minnesota, USA.

*Corresponding Author:
Michael Nguyen
Department of Laboratory Medicine and Pathology
University of Minnesota, USA.
E-mail: mnguye@stanfordmed.edu

Received: 10-Jun-2025, Manuscript No. AACPLM- 25-166918; Editor assigned: 11-Jun-2025, Pre QC No. AACPLM- 25-166918 (PQ); Reviewed: 20-Jun-2025, QC No. AACPLM- 25-166918; Revised: 21-Jun-2025, Manuscript No. AACPLM- 25-166918 (R); Published: 28-Jun-2025, DOI: 10.35841/ aacplm-7.2.258

Citation: Nguyen M. Anatomical pathology of hepatocellular carcinoma: A clinicopathologic review. J Clin Path Lab Med.2025;(7)2:258

Introduction

Hepatocellular Carcinoma (HCC) is the most common primary malignant tumor of the liver, accounting for over 80% of liver cancer cases globally. It typically arises in the background of chronic liver disease, especially cirrhosis caused by chronic Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), alcohol abuse, or Non-Alcoholic Fatty Liver Disease (NAFLD). Anatomical pathology provides critical insights into the diagnosis, staging, and prognosis of HCC through histopathologic evaluation and clinicopathologic correlation. [1].

Grossly, HCC may present as a single mass, multifocal nodules, or diffuse infiltrative growth. Tumor size can vary widely, and large tumors may exhibit areas of necrosis or hemorrhage. Microscopically, classic HCC is composed of malignant hepatocytes arranged in trabecular, pseudoglandular, or compact patterns. The degree of differentiation ranges from well to poorly differentiated, and histologic grading (such as the Edmondson-Steiner system) is a key prognostic factor.[2].

The cytologic features of HCC include increased nuclear-cytoplasmic ratio, nuclear pleomorphism, prominent nucleoli, and frequent mitotic figures. Immunohistochemistry (IHC) plays a crucial role in diagnosis, with markers such as HepPar-1, Glypican-3, Arginase-1, and heat shock protein 70 (HSP70) being commonly used. A panel of these markers enhances diagnostic accuracy, especially in poorly differentiated tumors. [3]

Vascular invasion, particularly into portal and hepatic veins, is a significant pathological finding and correlates with increased risk of recurrence and metastasis. Tumor encapsulation, satellite nodules, and bile duct involvement are additional important pathological features that influence staging and prognosis. Liver biopsy is reserved for atypical cases due to the risk of tumor seeding. When performed, histological confirmation provides definitive diagnosis and informs therapeutic decisions, including surgical resection, liver transplantation, or loco-regional therapies [4].

From a clinicopathologic perspective, HCC commonly presents with nonspecific symptoms such as abdominal pain, weight loss, and signs of liver dysfunction. Serum alpha-fetoprotein levels may be elevated in many patients, although this is not specific. Radiological imaging, especially contrast-enhanced CT or MRI, typically shows arterial enhancement and venous washout, which are characteristic features aiding diagnosis. Recent molecular studies have identified key genetic alterations in HCC, including mutations in TP53, CTNNB1 (β-catenin), and TERT promoter. These molecular markers are being increasingly integrated into pathological assessments and may help in stratifying patients for targeted therapies. [5].

Conclusion

Anatomical pathology remains the cornerstone of HCC diagnosis and management. Integration of histologic features, immunophenotype, molecular alterations, and clinical data offers a comprehensive approach for accurate classification and optimal treatment planning.

References

  1. Peerschke EI, Agrawal Y, Alexander CB, et al. Proposed research training guidelines for residents in laboratory medicine.Clin Lab Med. 2007;27(2):241-53.

    2. Indexed at, Google Scholar, Crossref

  2. Srinivasan D, Desai NR. The impact of the transition from volume to value on heart failure care: implications of novel payment models and quality improvement initiatives.J Card Fail. 2017;23(8):615-20.

    3. Indexed at, Google Scholar, Crossref

  3. Plebani M. Charting the course of medical laboratories in a changing environment.Clin Chim Acta. 2002;319(2):87-100.

    4. Indexed at, Google Scholar, Crossref

  4. Price CP, St John A, Christenson R, et al. Leveraging the real value of laboratory medicine with the value proposition.Clin Chim Acta. 2016; 462:183-6.

    5. Indexed at, Google Scholar, Crossref

  5. Plebani M. Quality and future of clinical laboratories: the Vico’s whole cyclical theory of the recurring cycles.Clin Chem Lab Med. 2018;56(6):901-8.

    6. Indexed at, Google Scholar, Crossref

Get the App