Clinical Aspects of Pathomorphological Diagnosis of Hepatocellular Cacinoma in Practical Oncology

Abstract

In modern clinical oncology, pathomorphological verification of the tumor substrate is key, the purpose of which is to determine the type and genotypic affiliation of the tumor process, which in turn determines further treatment tactics, the sequence of existing treatment methods, determination of sensitivity to treatment, and also determines the prognosis of the disease. Some nosologies known to oncology require not only a standard set of cytological and histological tests for malignant neoplasms, but also additional immunohistochemical and molecular genetic profiling, performed through biopsy, excisional biopsy, or diagnostic surgery. Furthermore, definitive diagnosis based on radiological examination (CT, MRI, PET/CT) and tumor marker titers in peripheral
blood remains clinically relevant. Currently, liver cancer hepatocellular carcinoma and/or cholangiocarcinoma is of greatest interest and complexity in the aforementioned verification. HCC ranks eighth in the oncological morbidity structure, with the number of newly diagnosed cases worldwide ranging from 820,000 to 850,000, with a consistent mortality rate of approximately 700,000 to 720,000 patients annually. This confirms the high mortality rate due to late staging of this pathology and the late onset of symptoms. This, in turn, determines the need for the introduction and application in clinical practice of periodic diagnostic and treatment protocols, the essence of which comes down to the existing algorithms for both diagnosis and treatment, according to which, in the case of widespread hepatocellular carcinoma/cholangiocarcinoma, when it is impossible to take biopsy material with the remaining risk of bleeding, CT/MRI confirmation of the characteristic pathognomonic signs of HCC/CCC with an increased titer level of the inherent tumor marker - AFP,
CEA is sufficient. In clinical oncology, discrepancies between clinical and radiological confirmation of the tumor’s progression are common during specialized treatment. This raises the question of repeat biopsy followed by histological review. This issue is particularly relevant in the case of HCC dissemination into brain structures, skeletal bones, and other anatomical sites, which are not typically associated with hematogenous and lymphogenous dissemination of this pathology, according to various literature data. We have described several cases of the aforementioned types of metastases and the specifics of their pathomorphological diagnosis.