# Clinicopathological Study on Morphological Subtypes of Hepatocellular Carcinoma: A Single Tertiary Referral Center Experience

## TL;DR

This study examines different types of liver cancer in a Dutch population and highlights the importance of thorough tumor sampling for accurate diagnosis and prognosis.

## Contribution

The study emphasizes the need for complete histomorphological evaluation of HCC resection specimens for accurate classification.

## Key findings

- Steatohepatic HCC was the most common subtype observed in the cohort.
- Most HCC cases showed multiple morphological patterns, complicating classification.
- HCC-NOS and heterogeneous HCC did not differ significantly in clinicopathological features or survival.

## Abstract

We aimed to analyze hepatocellular carcinoma (HCC) morphological subtypes characterized according to the WHO classification and the International Collaboration on Cancer Reporting (ICCR) recommendations, and their prognostic features in a Dutch population.

This retrospective study in a tertiary referral center included the histopathological revision of 62 HCC resection specimens, obtained from 22 female and 40 male patients (median age: 67 years), in a period between 2011 and 2021 at the Maastricht University Medical Center +. Clinical data, morphological subtypes, growth pattern (GP), tumor grade, tumor extension, margins, and vascular and perineural invasion were collected. Eighteen cases were assigned a specific morphologic subtype and steatohepatic HCC was the most common in our cohort. Twenty‐one tumors classified as conventional type HCC (HCC‐NOS), commonly exhibiting two concurrent GPs. Twenty‐three cases revealed a heterogeneous morphologic differentiation, compromising the combination of HCC‐NOS with another morphologic subtype, most frequently a steatohepatitic component. Comparison of HCC‐NOS and HCC with heterogeneous morphology did not show significant differences in the main clinicopathological characteristics and survival.

Although the most common morphologic subtype was steatohepatitic HCC, the majority of cases demonstrated multiple morphologic patterns. In case of HCC‐NOS, heterogeneous GPs were often observed. Therefore, a histomorphological diagnosis based on a single tumor biopsy specimen may lead to incorrect classification of HCC. Sufficient tumor sampling of HCC resection specimens is required for the complete evaluation of all histomorphological features followed by correct subclassification in order to meet the clinical needs regarding prognostic relevance and patient follow‐up.