Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Volume 11, Number 6, December 2018, pages 391-396

Steatohepatitic Variant of Hepatocellular Carcinoma: A Focused Review


Figure 1.
Figure 1. Histological features of steatohepatitic hepatocellular carcinoma (SH-HCC). (a) Core biopsy of hepatic parenchyma with extensive steatosis (H&E, × 40); (b) trichrome stain highlights thick bands of fibrosis with bridging (× 40); (c) absence of bile ducts/portal tracts as demonstrated by immunostain for cytokeratin 7 (× 40); (d) capillarization of tumor sinusoids highlighted by immunostain for CD34 (× 40).
Figure 2.
Figure 2. Histological features of steatohepatitic hepatocellular carcinoma (SH-HCC). (a) High magnification (H&E, × 400) reveals steatosis, ballooning and Mallory-Denk bodies within tumor cells; (b) isolated arterioles (arrows) without associated portal tracts (H&E, × 200).
Figure 3.
Figure 3. Potential tumorigenic pathways in the development of steatohepatitic hepatocellular carcinoma.


Table 1. Comparison of SH-HCC, Steatohepatitis, Conventional HCC and Steatohepatitic FNH on Resection
SH-HCCSteatohepatitisConventional HCCSteatohepatitic FNH
SH-HCC: steatohepatitic hepatocellular carcinoma; HCC: hepatocellular carcinoma; FNH: focal nodular hyperplasia. *It usually shows a map-like staining pattern.
Clinical settingMass, ill-defined lesion or abnormal imaging findingRandom biopsy from patients with or without metabolic risk factors, with or without liver function abnormalitiesMass or ill-defined lesionMass, ill-defined lesion or abnormal imaging finding, with or without a central scar
Macroscopic findingsMass, ill-defined lesion or vague abnormalities with gold-yellow appearanceNon-specificMass or ill-defined lesion with cut surface different from adjacent liverMass or ill-defined lesion with or without a central scar
  Relationship to adjacent liver parenchymaVariable (well demarcated to focally invasive into adjacent portal tracts)Non-invasiveVariable (well demarcated or invasive into adjacent portal tracts)Non-invasive
  Central scarVariableAbsentAbsentPresent in large lesions but variable in small lesions
  Portal tractsAbsentPresentAbsentAbsent
  Ductular reactionAbsentVariable but present in most casesAbsentPresent in fibrous septa
  Thick-walled vessels within fibrous bandsAbsentAbsentAbsentPresent
  Fibrous bandsVariableVariableVariablePresent
  Isolated arteries immediately in contact with hepatocytesPresentMay be present (small)PresentAbsent
 Small cell changeVariableAbsentPresent in many casesAbsent
 Increased nuclear/cytoplasmic ratioVariableAbsentPresentAbsent
  PleomorphismVariable (minimal to marked)Minimal to mildVariable (mild to marked)Minimal to mild
  Acinar/rosette formationAbsent to minimalAbsentVariable (absent to marked)Variable (small rosettes, focal)
  Mitotic figuresVariable (can be rare)AbsenceVariable (usually identifiable)Absence
  Capillarization of endotheliumVariableAbsencePresenceAbsence
  Hepatocyte ballooningPresencePresenceAbsencePresence
  Mallory-Denk BodiesPresencePresenceAbsencePresence
  InflammationPresence (mild to severe)Presence (mild to severe)VariableVariable
  Thick plates > 3 hepatocytesVariable presenceAbsenceVariable presenceVariable presence (limited in extent, focal)
  Reticulin fiberMay be lostMay be slightly attenuatedLost in most casesMay be slightly attenuated
  Diffuse sinusoidal CD34 stainingPresence in most casesAbsencePresenceAbsence
  Glypican-3Variable presence (cytoplasmic and canalicular)AbsencePresence in many casesAbsence
  Diffuse glutamine synthetaseVariable presence (cytoplasmic staining with perinuclear accentuation)AbsencePresence in many caseAbsence*
  Nuclear β-cateninPresence in 6% casesAbsencePresence in some casesAbsence