Steatohepatitic Hepatocellular Carcinoma, a Morphologic Indicator of Associated Metabolic Risk Factors: A Study From India

Abstract

Context.-The common risk factors for hepatocellular carcinoma (HCC) include persistent viral infection with either hepatitis B or C virus, alcohol abuse, hemochromatosis, and metabolic syndrome. Steatohepatitic (SH) HCC has been recently recognized as a special morphologic variant of HCC associated with metabolic risk factors.Objective.-To assess the SH pattern in HCC cases of various etiologies in Indian patients and to further correlate this morphology with the presence of metabolic risk factors.Design.-A total of 101 cases of HCC with various etiologies in explanted livers from adults were included in the study. Morphologic examination was performed to identify SH lesions within the tumor and in the nontumorous liver parenchyma. Correlation of nontumor and tumor SH morphology with clinically identifiable metabolic risk factors and with non-SH type of HCC was performed.Results.-The SH variant of HCC was identified in 19 livers (18.8%). Most SH-HCC cases were associated with metabolic risk factors such as obesity, diabetes, hypertension, and hyperlipidemias. Comparison of SH-HCC with non-SH-HCC was statistically significant in terms of presence of metabolic risk factors.Conclusions.-Steatohepatitic morphology in HCC is frequent in nonalcoholic fatty liver disease-associated cirrhosis (P ¼ .009) and is significantly associated with metabolic risk factors (P ¼ .03). By recognizing SH pattern, one may predict associated metabolic diseases and determine the prognosis both in pretransplant and posttransplant patients. (Arch Pathol Lab Med. 2013;137:961-966; doi: 10.5858/ arpa.2012-0048-OA) H epatocellular carcinoma (HCC) accounts for 85% to 90% of all primary liver cancers.1 There is wide geographic variation of prevalence of HCC, with Asia and Africa having 40 times more cases than other parts of the world.2 However, the incidence of HCC has been rising throughout the world, with particularly large increases seen in industrialized nations such as the United States and Denmark.3 Nonalcoholic fatty liver disease (NAFLD) ranges in severity from steatosis to steatohepatitis (NASH, nonalcoholic steatohepatitis) and finally to cirrhosis, which is known to be a risk factor for the development of HCC. 4 In Western and Asian countries, the prevalence of NAFLD in the general population is increasing dramatically.5 Genetic factors may in part contribute to the rise in NAFLD. Polymorphisms within various genes have been linked to NAFLD in lean Indian men.6 Emerging evidence has established multiple independent risk factors for the development of HCC in NAFLD, which include obesity, diabetes, and iron deposition. 7,8 Recently a new morphologic variant of HCC named steatohepatitic hepatocellular carcinoma has been identified that relates to the presence of metabolic syndrome.9,10 The aim of the study is to recognize steatohepatitic (SH) pattern in HCC cases of various etiologies in Indian patients and to further correlate this variant with the presence of metabolic risk factors. MATERIALS AND METHODSBetween January 2004 and ...

Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse

“…Our cohort with predominantly HBV‐infected Chinese patients (83.5%) was able to fill the potential knowledge gap. Our findings were largely consistent with those described previously and reinforced the distinguishing clinical association of steatohepatitic HCC with underlying fatty liver, steatohepatitis and metabolic risk . However, we demonstrated that steatotic HCC also has a characteristic association with underlying fatty liver, steatohepatitis and metabolic risks.…”

Non-alcoholic fatty liver disease: An expanded review

“…When examining patient characteristics, the steatohepatitic HCC variant patients showed higher numbers of metabolic syndrome risk factors as well as at least 3 components of metabolic syndrome[116]. In a separate study, Jain et al[118] found the steatohepatitic variant of HCC (SH-HCC) in approximately 19% of their cases over a period of 7 years, with 50% of those cases being seen in NAFLD patients and the other 50% were largely of HCV etiology. It is important to note, in a study performed by Yeh et al[119], that SH-HCC can occur outside the morphology of that seen in fatty liver disease or metabolic syndrome and was posited to be more likely attributable to genetic changes of shared genes or metabolic pathways.…”

Steatohepatitic Hepatocellular Carcinoma—A Case Report with Literature Review

“…Another study from India by Jain et al in 2013 also illustrated similar association of SH-HCC with the metabolic syndrome [6].…”