title: Hepatocellular Carcinoma and Its Precursors in 103 HBV-Related Cirrhotic Explanted Livers: A Study from South Iran.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors: Department of Pathology, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors: Shahrzad
authors: S
authors: Yazdanpanah
authors: Department of Pathology, Shiraz University of Medical Sciences, Shiraz, IR Iran; Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors: Bita
authors: B
authors: Geramizadeh
authors: Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Surgery, Hepatobiliary and Liver Transplant Section, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors: Saman
authors: S
authors: Nikeghbalian
authors: Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Surgery, Hepatobiliary and Liver Transplant Section, Shiraz University of Medical Sciences, Shiraz, IR Iran.
authors: Seyed Ali
authors: SA
authors: Malek-Hosseini
keywords: Cirrhosis; Hepatitis B; Hepatocellular Carcinoma; Precursors