Vascular Mechanisms During Hepatic Carcinogenesis And The Significances Of Expressions Of CD34, A-SMA In Small Hepatocellular Carcinoma

Objective: To investigate the clinical feature and the methods of early detection of liver hyperplastic nodule canceration to small HCC, and approach the mechanism of action of vasifaction in the canceration of HCC.Methods: Retrospective analysis the information of 45 small HCC, research the clinical pathological features. The 4 groups of that are 10 normal liver, 4 hyperplastic nodulars removed by operation, 45 small HCC and 25 large HCC. Use immuno-histochemistry CD34 marked vascular endothelial cell to view the changes of microvascular density. Review the expression of α-SMA in each group, and search for the specifical blood-supply arteries. Results:1. CD34 has little expression in sinus hepaticus of normal liver, the MVD of normal liver is 5.2±3.1;in hyperplastic nodular it is 11.3±4.7; in the small HCC ( < 2cm) ,it is 32.5±4.0 ; in the small HCC (2～5cm) , it is 56.8±8.0; and in large HCC it is 45.3±14.7. The MVD is increasing from normal liver to HCC. Compared the normal liver and hyperplastic nodular with HCC, there are obviously differences (p < 0.05), but the group of small HCC(2～5cm) and large HCC has no difference(p > 0.05).2. In group of normal liver , α-SMA has a poorly or no expression. We did not find specific blood-supply arteries. The group of hyperplastic nodular has a little expression of α-SMA, but we did not find obviously blood-supply arteries either. In the group of HCC ,the expression of α-SMA are all strongly positive, each group can find that positive expressed fibroblastic cells and stellate cells, one or more specific blood-supply arteries has been found.3. The pathological types of small HCC are hepatocellular carcinoma(95.6%), cholangiocellular carcinoma (2 % ) .The positive rate of HBV is 78%;the rate of AFP higher than 50ug/L is 40 % ;the ultrasound express of small HCC are mostly hepoechoic nodular(71.1 %); CT plain scan can find that low density focus (60.6%) , in artery phase enhancement, we can find blood-supply arteries; we usually use local excision or segmentectomy to cue small HCC.Conclusion: Vasculogenisis plays an important role in the canceration of liver hyperplastic nodulars, CD34 marked vascular endothelial cell and α-SMA marked specific blood-supply artery are the one of the important mechanisms of early canceration and promote tumor grows. Investigation of α-SMA protein, examinations with CT or ultrasound can be able to detect the specific blood-supply artery of HCC. It is helpful to diagnosis .