ADENOMATOUS HYPERPLASIA IN CIRRHOTIC LIVERS - HISTOLOGICAL-EVALUATION, CELLULAR DENSITY, AND PROLIFERATIVE ACTIVITY OF 35 MACRONODULAR LESIONS IN THE CIRRHOTIC EXPLANTS OF 10 ADULT FRENCH PATIENTS

We examined 41 consecutive cirrhotic liver explants from French patien ts for the presence of nodules of adenomatous hyperplasia (AH) and the n analyzed these lesions, together with underlying cirrhosis (C) and a ssociated hepatocellular carcinoma (HCC), for various histological par ameters, cellular density, and proliferative activity. Thirty-five AHs were identified in 10 livers (prevalence, 24%); seven of 10 were HCV positive. Hepatocellular carcinoma was more frequent in patients with AH than in patients without. The AHs consisted of 17 ordinary (OAH) an d 18 atypical (AAH) adenomatous hyperplasia lesions. There was a malig nant focus in five of the 18 AAHs. Wide areas of large liver cell dysp lasia were frequent in OAH but never found in AAH. Obvious steatosis w as frequent in HCC but excep tional in AAH and absent in OAH. There wa s a significant increase in cellular density in AAH and HCC as compare d with C and OAH. Proliferative cell nuclear antigen immunostaining si milarly showed an increase in proliferation from OAH or C to AAH and H CC. These data suggest that, in Europe as in Japan, one pathway of hep atocarcinogenesis is a multistep process in which AAH should be consid ered as a premalignant lesion very close to grade I HCC, while OAH see ms to correspond to a regenerative nodule with limited proliferative a bility. Copyright (C) 1995 by W.B. Saunders Company.