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Hepatozelluläre Karzinome in der nichtzirrhotischen Leber

Hepatocellular carcinoma in the non-cirrhotic liver

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Zusammenfassung

Das hepatozelluläre Karzinom (HCC) entsteht zu etwa 15–20% in nichtzirrhotischen Lebern. Alle Ursachen, die ein HCC in einer Leberzirrhose (LZ) verursachen, können auch ohne Zirrhose zu einem HCC führen. Nach der relativen Häufigkeit kann man grob 3 Gruppen von Erkrankungen unterscheiden. 1. HCC, die selten ohne LZ entstehen (z. B. Virushepatitis, Alkoholabusus). 2. HCC, die häufiger auch ohne LZ entstehen (z. B. Alpha-1-Antitrypsin-Mangel, Hämochromatose, nichtalkoholische Fettlebererkrankung). 3. HCC, die grundsätzlich ohne LZ entstehen (z. B. Glykogenose Typ 1, Gebrauch oraler Kontrazeptiva/anaboler Steroide). In Fällen der Gruppen 1 und 2 war die notwendige zytotoxische Dosis der Noxe zum Erreichen einer LZ noch nicht erreicht, der karzinogene Effekt hingegen schon wirksam, möglicherweise begünstigt durch Ko-Karzinogene und Wirtsfaktoren. Karzinogene der Gruppe 3 verändern eher adaptativ den hepatozellulären Metabolismus ohne nennenswerte Zytotoxizität, können aber bei langfristiger Einwirkung dennoch zu HCC führen. Insbesondere in diesen Fällen entstehen die Karzinome oft über die Zwischenstufe des hepatozellulären Adenoms (Adenom-Karzinom-Sequenz).

Abstract

Of hepatocellular carcinomas (HCC), 15–20% occur in the non-cirrhotic liver. All factors which cause HCC when liver cirrhosis (LC) is present, can also lead to HCC without LC. On the basis of the relative frequency, HCC can be roughly differentiated into 3 groups: 1) HCC, rarely occurring without cirrhosis (e.g. virus hepatitis, alcohol abuse). 2) HCC, frequently occurring without LC (alpha1-antiytrypsin deficiency, hemochromatosis, non-alcoholic fatty liver disease). 3) HCC, consistently occurring without LC (glycogen storage disease type 1, consumption of oral contraceptives/anabolic steroids). In groups 1 and 2 the level of hepatocellular toxicity necessary to reach LC is not yet achieved but the carcinogenic effect is already strong enough to induce HCC, possibly owing to the influence of additional carcinogens or host factors. In group 3, the carcinogenic effect is mediated by a long-standing alteration of the hepatocellular metabolism that is of low toxic effect and does not lead to cell death, but is nevertheless carcinogenic. In these cases, the initial formation of hepatocellular adenomas that subsequently transform into HCC is a common finding (adenoma-carcinoma sequence).

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  1. Institut für Pathologie, Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 23e, 17489, Greifswald, Deutschland

    M. Evert &  F. Dombrowski

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  1. M. Evert
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  2. F. Dombrowski
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Correspondence to F. Dombrowski.

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Evert, M., Dombrowski, F. Hepatozelluläre Karzinome in der nichtzirrhotischen Leber. Pathologe 29, 47–52 (2008). https://doi.org/10.1007/s00292-007-0953-3

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