Scirrhous changes in dysplastic nodules do not indicate high‐grade status

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Abstract
Background and Aims: Dysplastic nodules (DN) may be divided into high‐grade and low‐grade, and the former has been known as a precancerous or borderline lesion. Recently many morphological characteristics concerning these types of DN have been reported. In the present study we attempted to evaluate the scirrhous change in DN as an indicative feature of high‐grade DN, based on the morphological and cell‐kinetic analyses using immunohistochemical stains for Ki‐67. Methods: We reviewed 35 livers with DN and selected 15 DN with scirrhous change. We stained DN‐bearing sections of each case with hematoxylin and eosin, trichrome, reticulin and Perls’ stain. We tried to subclassify and characterize the scirrhous change according to the fibrosis pattern. We also stained with Ki‐67 immunohistochemically to assess the proliferative activity of DN with scirrhous change. Results: We found two types of scirrhous change, that is, pericellular and stellate. The pericellular type was related to the Mallory body‐forming cholestatic degeneration, whereas the stellate type was associated with extensive portal fibrosis probably induced by ischemic damage. Among DN with scirrhous change, high‐grade DN comprised five nodules (33%) and there were 10 (67%) low‐grade nodules. There was no significant relationship between the presence or the types of scirrhous change and the grade of DN. The significant differences of Ki‐67 labeling indices between types of scirrhous change were not shown in this study. We also could not find the differences between Ki‐67 labeling indices of scirrhous DN (high and low grades) and those of surrounding regenerative nodules. Conclusions: This evidence indicated that the scirrhous change in DN was not a specific feature of high‐grade DN. We also found that scirrhous DN have two morphological varieties that may represent biologically different processes, that is, pericellular scirrhous type and stellate scirrhous type.