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Diagnose und Differenzialdiagnose des hepatozellulären Karzinoms

Diagnosis and differential diagnosis of hepatocellular carcinoma

  • Schwerpunkt: Lebertumoren
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Zusammenfassung

Die Häufigkeit des hepatozellulären Karzinoms (HCC) wird noch zunehmen. Das beruht größtenteils auf den bis zu 30 Jahren nach Hepatitis-C-Virusinfektion auf dem Boden einer Leberzirrhose entstehenden Karzinomen. Die Feststellung einer Leberzirrhose ist von Bedeutung bei Diagnosestellung eines HCC. Das HCC wird nach WHO-Empfehlung in einen trabekulären, pseudoglandulären, azinären, kompakten, zirrhösen sowie in einen fibrolamellären Subtyp eingeteilt. Die zytologische Unterteilung umfasst den hepatozytären, pleomorphen, klarzelligen und sarkomatösen Typ. Intrazytoplasmatische Einschlüsse sind differenzialdiagnostisch hilfreich, wie auch zahlreiche Antikörper. Die Differenzialdiagnosen sind lebereigene Tumoren wie Leberzelladenome oder Vorstufen des HCC wie dysplastische Knoten, aber auch Metastasen. Mesenchymale Tumoren können differenzialdiagnostisch Schwierigkeiten bereiten, vor allem wenn in der Biopsie kein nichttumoröses Lebergewebe erfasst ist.

Abstract

The incidence of hepatocellular carcinoma (HCC) will continue to increase for the next decade due to a latency of about 30 years due to cirrhosis caused by chronic hepatitis C. The diagnosis of an underlying cirrhosis is of diagnostic importance. According to WHO guidelines, HCC encompasses the following: trabecular, pseudoglandular, acinar, compact, scirrhous and fibrolamellar subtypes. Cytological appearance includes hepatocellular pleomorphic, clear cell and sarcomatous subtypes. Tumor cells in hepatocellular carcinoma may display intracytoplasmic inclusions that are helpful for establishing the diagnosis. Differential diagnosis has to be considered for such hepatic tumors as adenoma and precancerous lesions such as dysplastic nodules or mesenchymal tumors. Metastases in the liver may be difficult to differentiate, especially for primary tumors from the gastrointestinal tract which may be similar to glandular or scirrhous type of HCC. The existence of underlying cirrhosis is helpful for the diagnosis and an ample spectrum of antibodies against liver antigens and adenocarcinomas are commercially available to confirm the correct diagnosis.

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  1. Institut für Pathologie der Universität zu Köln, Joseph-Stelzmann-Straße 9, 50931, Köln

    U. Drebber & H. P. Dienes

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  1. U. Drebber
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  2. H. P. Dienes
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Correspondence to U. Drebber.

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Drebber, U., Dienes, H.P. Diagnose und Differenzialdiagnose des hepatozellulären Karzinoms. Pathologe 27, 294–299 (2006). https://doi.org/10.1007/s00292-006-0842-1

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