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World J Gastroenterol. Mar 28, 2016; 22(12): 3305-3314
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3305
Latest developments in precancerous lesions of hepatocellular carcinoma
Zhao-Shan Niu, Xiao-Jun Niu, Wen-Hong Wang, Jing Zhao
Zhao-Shan Niu, Laboratory of Micromorphology, Medical College of Qingdao University, Qingdao 266071, Shandong Province, China
Xiao-Jun Niu, Clinical Medicine Specialty, Medical College of Qingdao University, Qingdao 266071, Shandong Province, China
Wen-Hong Wang, Department of Pathology, Medical College of Qingdao University, Qingdao 266071, Shandong Province, China
Jing Zhao, Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao 266061, Shandong Province, China
Author contributions: Niu ZS designed the study and wrote the manuscript; Niu XJ and Wang WH searched the literature for the latest developments in the field; Zhao J assisted in the preparation of figures.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zhao-Shan Niu, MD, Laboratory of Micromorphology, Medical College of Qingdao University, Room 201, Building Boya, No. 308 Ningxia Road, Qingdao 266071, Shandong Province, China. niumiao1993@hotmail.com
Telephone: +86-532-83780012 Fax: +86-532-83780012
Received: August 19, 2015
Peer-review started: September 13, 2015
First decision: November 11, 2015
Revised: November 16, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: March 28, 2016
Processing time: 194 Days and 20.8 Hours
Abstract

Hepatocarcinogenesis in human chronic liver diseases is a multi-step process in which hepatic precancerous lesions progress into early hepatocellular carcinoma (HCC) and progressed HCC, and the close surveillance and treatment of these lesions will help improve the survival rates of patients with HCC. The rapid development and extensive application of imaging technology have facilitated the discovery of nodular lesions of ambiguous significance, such as dysplastic nodules. Further investigations showed that these nodules may be hepatic precancerous lesions, and they often appear in patients with liver cirrhosis. Although the morphology of these nodules is not sufficient to support a diagnosis of malignant tumor, these nodules are closely correlated with the occurrence of HCC, as indicated by long-term follow-up studies. In recent years, the rapid development and wide application of pathology, molecular genetics and imaging technology have elucidated the characteristics of precancerous lesions. Based on our extensive review of the relevant literature, this article focuses on evidence indicating that high-grade dysplastic nodules are more likely to transform into HCC than low-grade dysplastic nodules based on clinical, pathological, molecular genetic and radiological assessments. In addition, evidence supporting the precancerous nature of large cell change in hepatitis B virus-related HCC is discussed.

Keywords: Hepatocellular carcinoma; Precancerous lesions; High-grade dysplastic nodule; Large cell change; Small cell change

Core tip: The identification and characteristics of hepatic precancerous lesions may serve as early clues to malignant transformation. Over the last 10 years, studies of precancerous lesions have resulted in significant progress, especially in molecular biology and imaging technology. Based on our extensive review of the relevant literature, this article focuses on evidence that supports the precancerous nature of dysplastic foci and dysplastic nodules from a clinical, pathological, molecular genetic and radiological point of view.