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Hepatozelluläres Karzinom

Hepatocellular carcinoma

  • Schwerpunkt: Leberpathologie
  • Published:
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Zusammenfassung

Das hepatozelluläre Karzinom (HCC) gehört zu den häufigsten und tödlichsten Krebserkrankungen weltweit. Die zugrunde liegenden Risikofaktoren (vor allem chronische Virushepatitis und alkoholische/nichtalkoholische Steatohepatitis) führen zur Entwicklung einer Leberzirrhose, einer prämalignen Kondition für die Entwicklung präneoplastischer hepatozellulärer Läsionen und schließlich des Leberkrebses. Frühe HCC können unter Anwendung histologischer Kriterien und eines immunhistologischen Markerpanels in der Regel bereits in Biopsiepräparaten von prämalignen Vorläuferläsionen und anderen hochdifferenzierten hepatozellulären Läsionen abgegrenzt werden. Durch integrative Charakterisierung konnten molekulare HCC-Subgruppen und histologische Differenzierungsmuster assoziiert werden. Diese möglicherweise klinisch relevante Entwicklung trug dazu bei, dass in der kürzlich veröffentlichten, aktualisierten WHO-Klassifikation der Leberkarzinome neue HCC-Subtypen eingeführt wurden. Diese sollen sich in Bezug auf Morphologie, molekulare Veränderungen, biologisches Verhalten und ihre klinischen Charakteristika von den übrigen HCC unterscheiden. Ob hierdurch der Grundstein für eine Präzisionstherapie von HCC-Patienten gelegt wurde, wird die Zukunft zeigen.

Abstract

Hepatocellular carcinoma (HCC) belongs to the most prevalent and deadliest cancers worldwide. It can be attributed to well-defined risk factors (mainly chronic viral hepatitis and alcoholic/nonalcoholic steatohepatitis) leading to liver cirrhosis, a premalignant condition for the development of preneoplastic hepatocellular lesions and finally liver cancer. By applying strict morphological criteria and a panel of immunohistological markers, early HCC can be differentiated from its precursor lesions and other highly differentiated hepatocellular lesions even in most biopsy specimens. Integrative characterization led to the association of histological features and molecular subgroups of human HCC. This potentially relevant clinical development was recognized by the recently updated WHO classification of liver cancer resulting in the introduction of several HCC subtypes. These are characterized by a distinct combination of histological and molecular features, biological behavior, and clinical characteristics, allowing for a distinction from other HCC without specified features. Whether this development sets the corner stone for precision oncology of human HCC patients must be monitored.

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Abbreviations

AFP:

α‑Fetoprotein

BerEP4:

„Epithelial cell adhesion molecule“ (EpCAM)

CD:

„Cluster of differentiation“

CDKN2A:

„Cyclin dependent kinase inhibitor 2A“

CEA:

Carcinoembryonales Antigen

CTNNB1:

β‑Catenin-Gen

DN:

„Dysplastic nodule“, dysplastischer Knoten

DNAJB1:

„DnaJ heat shock protein family (Hsp40) member B1“

EBV:

Epstein-Barr-Virus

FGF19:

„Fibroblast growth factor 19“

FLC:

Fibrolamelläres Karzinom

G‑CSF:

„Granulocyte-colony stimulating factor“

GPC3:

Glypican‑3

GS:

Glutaminsynthetase

H&E:

Hämatoxylin-Eosin-Färbung

HBV:

Hepatitis-B-Virus

HCA:

Hepatozelluläres Adenom

HCC:

Hepatozelluläres Karzinom

HCV:

Hepatitis-C-Virus

HGDN:

High-grade dysplastischer Knoten

HSP70:

„Heat shock protein 70“

IL‑6:

Interleukin‑6

JAK:

Januskinase

LGDN:

Low-grade dysplastischer Knoten

PD1:

„Programmed death-1“

PD-L1:

„Programmed death‑1 ligand 1“, CD274

PIK3CA:

Phosphatidylinositol‑4,5‑Bisphosphate-3-Kinase, katalytische Untereinheit α

PKA:

Proteinkinase A

PRKACA:

cAMP-abhängige Proteinkinase, katalytische Untereinheit α

RNA:

Ribonukleinsäure

SALL4:

„Spalt-like transcription factor 4“

STAT:

„Signal transducer and activator of transcription“

TCGA:

The Cancer Genome Atlas

TERT:

„Telomerase reverse transcriptase“

TP53:

Tumorprotein P53

TSC1/2:

Tuberöse-Sklerose-Komplex, Untereinheit 1/2

WHO:

World Health Organization

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Danksagung

Ich danke den Mitarbeitenden unseres Diagnostiklabors für die Unterstützung bei der Identifikation illustrativer Fallbeispiele und die Anfertigung ergänzender immunhistologischer Färbungen.

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  1. Pathologisches Institut, Uniklinikum Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Deutschland

    Thomas Longerich

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Correspondence to Thomas Longerich.

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T. Longerich gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schwerpunktherausgeber

H. Baba, Essen

T. Longerich, Heidelberg

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Longerich, T. Hepatozelluläres Karzinom. Pathologe 41, 478–487 (2020). https://doi.org/10.1007/s00292-020-00801-z

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  • DOI: https://doi.org/10.1007/s00292-020-00801-z

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