Clinicopathological Features and Metastatic Pattern of Hepatocellular Carcinoma: An Autopsy Study of 398 Patients

Abstract

Objectives: Analysis of a large local autopsy collective to gather epidemiological and histopathological data on hepatocellular carcinoma (HCC). Methods: We examined a large dataset of 44,104 autopsies performed at the Institute of Pathology, Basel, Switzerland, including 2 autopsy collectives (1969-1983 and 1988-2012) to gather current data on HCC in the advanced stage. A total of 398 HCC were diagnosed, accounting for around 1% of all autopsies. Results: As expected, most patients developing HCC had advanced stages of liver fibrosis or cirrhosis (F3/F4). However, in the more recent autopsy collective (1988-2012), our data also show an increase of HCC arising in livers without or with only mild to moderate fibrosis (F0-F2). Extrahepatic metastasis was found in 156 of 398 HCC (39.1%), with lung metastasis (74.5%) being the most common, followed by the bones (24.8%) and adrenal glands (19.1%). Conclusions: Our data therefore seem to suggest that, in the last 2 decades, despite the introduction of new therapeutic modalities for HCC, no significant changes have been observed regarding the metastatic pattern of advanced HCC.

Hepatocellular Carcinoma Xenografts Established From Needle Biopsies Preserve the Characteristics of the Originating Tumors

“…We next investigated whether the individual PDX tumors retained the histologic characteristics of the original human tumors. HCC PDX tumors maintained the differentiation grade, growth pattern, and cytologic subtype of the originating human HCC biopsies over at least 4 generations (Table ; Fig. ; Supporting Fig.…”

“…We next investigated whether the individual PDX tumors retained the histologic characteristics of the original human tumors. HCC PDX tumors maintained the differentiation grade, (17) growth pattern, and cytologic subtype (30,31) of the originating human HCC biopsies over at least 4 generations (Table 1; Table 1). Of note, only in one case (PDX model C284b) did we observe the loss of the trabecular aspect of the growth pattern that was present in the original biopsy; however, the solid growth pattern and differentiation grade were maintained over subsequent 976 passages from mouse to mouse (Table 1; Supporting Fig.…”

Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center

“…Particularly patients with advanced intrahepatic lesions (tumor stages T3 and T4), vascular invasion, elevated tumor markers, and viral hepatitis have a higher risk for extrahepatic metastases from HCC with an incidence of 13.5%-42%. Furthermore, extrahepatic metastases especially after liver transplantation are more aggressive compared to those occurring in patients without liver transplantation [ 2 – 6 ]. Generally, HCC disseminates via the lymphatic or vascular pathway affecting lymph nodes (33.8%) and most frequently the lung (53.8-74.5%), followed by the bones (24.8-38.5%) and the adrenal glands (8-19.1%) [ 1 , 2 , 4 , 6 – 9 ].…”

“…Furthermore, extrahepatic metastases especially after liver transplantation are more aggressive compared to those occurring in patients without liver transplantation [ 2 – 6 ]. Generally, HCC disseminates via the lymphatic or vascular pathway affecting lymph nodes (33.8%) and most frequently the lung (53.8-74.5%), followed by the bones (24.8-38.5%) and the adrenal glands (8-19.1%) [ 1 , 2 , 4 , 6 – 9 ]. Different therapeutic strategies like local ablative methods and systemic therapy as well as surgery have been considered for the therapy of adrenal metastasis of HCC.…”

Seminal vesicle metastasis after liver transplantation for hepatocellular carcinoma

“…This patient had metastases that occurred in liver, adrenal gland, intestinal wall, and seminal vesicle. Furthermore, extrahepatic metastases especially after LT are more aggressive compared to those occurring in patients without LT. [4,5] Adrenalectomy is a safe procedure and leads to acceptable survival rates even after LT. [6] However, metastasis from HCC to the seminal vesicle has only been reported once but only in a patient with HCC that did not receive LT. [7]…”