Some liver cancers are not even typical HCC, but are composed primarily of small spindled cells, are difficult to characterize as epithelial by conventional immunohistochemical markers for

HCC, and best labeled simply as “primary liver cancer”, and their outcome may be considered similar to that of other undifferentiated primary carcinomas. We now recognize liver carcinomas can also be characterized as having arisen from the Hering canal (progenitor) cells (so-called cholangiolocarcinoma). These tumors Afatinib research buy have a striking histologic appearance of altered cord-like and antler-shaped structures within a dense stromal background, often reminiscent check details of an aberrant ductal plate, and differ in many ways from conventional cholangiocarcinoma. If these tumors

and their stromal components are never carefully documented histologically, results of the sophisticated molecular -omics, micro-RNA studies will continue to be heterogenous, unfocused, and essentially irreproducible. We are, we fear, losing a valuable opportunity to correlate genotypic information with histopathologic phenotype of the plethora of cancers in these studies. In most published manuscripts on molecular signatures of HCC, the cancer phenotype presented is limited to size and number of lesions, presence of microvascular invasion, serum alpha-fetoprotein levels, and, of course, very disease recurrence or survival. Detailed histopathology is commonly missing from such articles and, yet, has much to offer. An example of this lack of attention to details of histopathology at the recent ILCA meeting was the luncheon workshop for Molecular Markers of HCC. Both moderators made

a point of stating early on in the meeting that “liver biopsies need to be done on all liver cancer”. Why, they asked? They went on to answer: To be able to study predictors (molecular), as well as prognosis (molecular). Also noted, however, in the seminar was the diversity of (molecular) platforms for these highly sophisticated studies, the plethora of genetic, inflammatory, metabolic pathways and data being generated, and our current need, therefore, for highly sophisticated, costly, and center-specific techniques for analysis of large numbers of cases and datasets. Yet, no discussion whatsoever occurred of the possible presence or significance of correlations or differentiating histopathologic subtypes. It seems unfortunate that the history of our discipline in hepatology is rapidly being lost to the memories of the young generation.