Background/aims: Liver cell dysplasia of large (LLCD) and small (SLCD) cell types may represent a premalignant change. We sought to evaluate their prevalence, relationship with the gross type of cirrhosis, aetiology of liver disease, and the presence of hepatocellular carcinoma in a series of cirrhotic livers.
Methods: The presence and pattern of SLCD and LLCD were evaluated by careful histological analysis in 100 consecutive cirrhotic livers of viral (49%) or non viral (51%) aetiology, and with or without hepatocellular carcinoma. Prevalences were compared using Chi-square or Fisher's tests; relative risk for hepatocellular carcinoma was evaluated by the odds ratio.
Results: Dysplasia was found in 82/100 of livers. Eighty-one had LLCD, with (n=49) or without (n=32) associated SLCD. SLCD alone was found in only one case. LLCD and SLCD tended to be more frequent and extensive in mixed or macronodular cirrhosis than in micronodular cirrhosis. LLCD was significantly more frequent and extensive in cirrhosis due to hepatitis B, as was SLCD in cirrhosis due to hepatitis B virus or biliary diseases, where it showed a different pattern (focal vs diffuse, respectively). LLCD and SLCD were both significantly associated with the presence of hepatocellular carcinoma, even of small size. Small foci of SLCD and widespread LLCD were the two conditions which showed the strongest association with hepatocellular carcinoma, with odds ratios of: 6.33 and 3.88, respectively. Widespread SLCD was not relevant for hepatocellular carcinoma in biliary diseases.
Conclusions: Liver cell dysplasia may be considered an additional risk factor for hepatocellular carcinoma in patients with cirrhosis and should be looked for in biopsies. Widespread LLCD and SLCD with a focal pattern are particularly relevant for hepatocellular carcinoma, whereas widespread small cell changes found in biliary diseases seem to have a different biological significance.