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International Journal of Hepatology
Volume 2011 (2011), Article ID 241652, 7 pages
Review Article

Assessment of Stromal Invasion for Correct Histological Diagnosis of Early Hepatocellular Carcinoma

Department of Pathology, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan

Received 28 February 2011; Accepted 10 April 2011

Academic Editor: Ryosuke Tateishi

Copyright © 2011 Fukuo Kondo. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Stromal invasion (invasive growth of tumor tissue into portal tracts and fibrous septa) is now recognized as the most important finding in the diagnosis of the well-differentiated type of early hepatocellular carcinomas (HCCs). In differentiating stromal invasion from pseudoinvasion (benign hepatic tissue in fibrous stroma), the following 5 items are useful: (1) macroscopic or panoramic views of the histological specimen, (2) the amount of fibrous components of stroma, (3) destruction of the structure of portal tracts, (4) loss of reticulin fibers around cancer cells, and (5) cytokeratin 7 immunostaining for ductular proliferation. Knowledge of stromal invasion is also useful for a better understanding of the vasculature (hypovascular HCCs) and histological features (fatty change) of early HCCs. Invasion of preexisting arteries and portal veins causes hypo-vascularity of HCCs. Further, hypovascularity causes fatty change as a hypoxic change of cancer tissues.