Hepatocellular Carcinoma and Its Precursors in 103 HBV-Related Cirrhotic Explanted Livers: A Study from South Iran

Background: the most common cause of liver transplantation in iran is hepatitis b positive cirrhosis, and it also one of the major and important causes of hepatocellular carcinoma (hcc). most cases with hcc follow a multistep sequence. morphologic lesions during hepatocarcinogenesis include dysplastic lesions and small cancerous lesions (2 cm in diameter; early hcc). however, insufficient information is available on the incidence of hcc and its precursors in hepatitis b-related cirrhosis. objectives: in this study, we determined the incidence of hcc and its precursors in hepatitis b-related cirrhosis in the largest liver transplant center in iran. methods: in a two-year study, all explanted livers of patients with hepatitis b virus (hbv)-positive cirrhosis were completely sectioned and examined. each specimen was investigated grossly and microscopically to determine any abnormal nodule or cellular changes (at least 15 sections from each liver). results: among all explanted cirrhotic livers (103 livers) during the study period (2014 - 2015), 92 (89.3%) had dysplastic foci with large cell changes (lcc), 57 (55.3%) of which showed small cell changes (scc) as well. thirty-nine cases (37.9%) had low-grade dysplastic nodules (lgdn), 38 (36.9%) high-grade dysplastic nodules (hgdn), 19 (18.4%) were early hepatocellular carcinoma (ehcc), and 21 (20.4%) were hepatocellular carcinoma more than 2 cm. all the cases with ehcc and hcc of more than 2 cm also had scc, lcc, hgdn, and lgdn. thirteen cases of ehcc were accompanied with hccs more than 2 cm, and 6 cases of ehcc did not show any hcc (larger than 2 cm). conclusions: scc, lgdn, and hgdn are common associated findings and precursors of hcc in livers infected with hepatitis b. a strict follow-up and a precise and thorough sampling of livers with scc and any abnormal dysplastic nodules (dns), especially those larger than 1 cm, are highly recommended because these dns are highly associated with malignancy.