Histopathological evaluation of recurrent hepatitis C after liver transplantation:A review

Although the morphological features of hepatitis C virus(HCV)recurrence after orthotopic liver transplantation(OLT)have been well established in the last decades,the differential diagnosis still represents a challenge for the pathologist,especially early recurrent hepatitis C vs mild acute cellular rejection.The present review focuses on the role of the pathologist and the pathology laboratory in the management of recipients with recurrent hepatitis C,the usefulness of early and late post-OLT liver biopsies,and the potential role of ancillary techniques(immunohistochemistry and reverse transcription-polymerase chain reaction,RT-PCR).The English literature on the topic is reviewed,focusing on the histopathology,the immunohistochemistry and the use of RT-PCR on HCV-positive post-OLT biopsies.The different histopathological illustrations of early and chronic recurrent hepatitis C are presented,with special focus on the main differential diagnoses and those features with prognostic relevance(cholestasis above all).The usefulness of ancillary techniques are discussed,especially HCV RNA quantitation by RT-PCR.Finally,the usefulness of long-term protocol biopsies is addressed:their usefulness for the study of allograft disease progression is clear,but their meaning in the long term is still debated.The significance of plasma cell infiltrate in HCV-positive allografts,the prognostic weight of graft steatosis,and the impact of donor age in recurrent hepatitis C also represent additional open issues.

Correlation of molecular alterations with pathological features in hepatocellular carcinoma:Literature review and experience of an Italian center

Hepatocellular carcinoma(HCC)represents the primary carcinoma of the liver and the fourth leading cause of cancer-related deaths.The World Health Organization estimates an increase in cases in the coming years.The risk factors of HCC are multiple,and the incidence in different countries is closely related to the different risk factors to which the population is exposed.The molecular mechanisms that drive HCC tumorigenesis are extremely complex,but understanding this multistep process is essential for the identification of diagnostic,prognostic,and therapeutic markers.The development of multigenic nextgeneration sequencing panels through the parallel analysis of multiple markers can provide a landscape of the genomic status of the tumor.Considering the literature and our preliminary data based on 36 HCCs,the most frequently altered genes in HCCs are TERT,CTNNB1,and TP53.Over the years,many groups have attempted to classify HCCs on a molecular basis,but a univocal classification has never been achieved.Nevertheless,statistically significant correlations have been found in HCCs between the molecular signature and morphologic features,and this leads us to think that it would be desirable to integrate the approach between anatomic pathology and molecular laboratories.