Proposal for standardized criteria for the diagnosis of benign, borderline, and malignant hepatocellular lesions arising in chronic advanced liver disease

Am J Surg Pathol. 1993 Nov;17(11):1113-23. doi: 10.1097/00000478-199311000-00004.


Although current literature contains many cases of putative premalignant hepatocellular proliferations and small hepatocellular carcinomas, no consistent nomenclature and diagnostic criteria have been put forward to describe them. These nodules, which are being detected by radiographic techniques in cirrhotic livers and removed during transplantation procedures, represent a new and challenging histologic spectrum of liver pathology. In this study, a multinational panel of five liver pathologists reviewed 23 such nodules and were able to reach a consensus on the diagnostic criteria and to devise a standard nomenclature to describe the histologic lesions. We recommend that benign nodules showing little histologic difference from cirrhotic nodules be classified as regenerative or macroregenerative, and nodules with atypical features not diagnostic of carcinoma be classified as borderline. Such standardization should facilitate further study of the pathologic features and clinical behavior of these lesions.

MeSH terms

  • Adult
  • Carcinoma, Hepatocellular / etiology
  • Carcinoma, Hepatocellular / pathology*
  • Female
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / pathology*
  • Liver Neoplasms / etiology
  • Liver Neoplasms / pathology*
  • Male
  • Middle Aged
  • Observer Variation
  • Reference Standards