Objective: The hemoglobin, albumin, lymphocyte, and platelet (HALP) score has been extensively studied as a prognostic biomarker in various malignancies; however, its predictive value for pathological response to neoadjuvant chemotherapy remains unclear. This study aimed to evaluate the association between the pretreatment HALP score and tumor regression grade (TRG) in patients with locally advanced gastric cancer (LAGC). Material and Methods: This retrospective single-center study included 65 patients with histologically confirmed LAGC who received neoadjuvant fluorouracil, leucovorin, oxaliplatin, and docetaxel chemotherapy followed by curative-intent surgery. The HALP score was calculated using baseline laboratory parameters obtained prior to treatment initiation. Pathological response was assessed using the Mandard TRG system. Receiver operating characteristic (ROC) analysis was used to determine the optimal HALP cut-off value. Logistic regression analysis was performed to identify predictors of treatment response. Results: Among the 65 patients, 34 (52.3%) were classified as good responders and 31 (47.7%) as poor responders. The HALP score was significantly higher in good responders (46.3±25.1 vs. 30.8±20.0; p=0.006). ROC analysis demonstrated moderate discriminatory ability [area under the curve: 0.700; 95% confidence interval (CI): 0.570-0.830; p=0.006], with an optimal cut-off value of 38.6. Low HALP scores were significantly associated with poor response (p=0.001) and with more advanced pathological stages. In logistic regression analysis, HALP was the only significant predictor of treatment response (odds ratio: 0.16; 95% CI: 0.05-0.49; p=0.001). Conclusion: The pretreatment HALP score is significantly associated with pathological response to neoadjuvant chemotherapy in LAGC. As a simple and accessible biomarker, HALP may aid in pre-treatment risk stratification and treatment decision-making. Prospective validation is warranted.

Aim: Molecular classifications in gastric cancer are expensive and require experience. This study aimed to establish a molecular-like classification and to investigate the correlation of the classification with clinicopathological features and its prognostic significance. Materials-Methods: In 202 gastric cancer patients who underwent surgery between 2011 and 2019, the clinicopathological features of the tumors were re-evaluated, and the tumors were grouped by molecular-like classification using immunohistochemistry (MLH1, PMS2, MSH2, MSH6, p53, E-cadherin) and chromosomal in situ hybridization (EBER): EBV positive tumors (EBV+), tumors with microsatellite instability (MSI), genomically stable tumors (GS), chromosomal unstable tumors (CUN) and unclassifiable gastric tumors (G-NOS). Results: Twelve of the patients were in the EBV+, 22 in the MSI, 27 in the GS, 76 in the CUN and 65 in the G-NOS group. EBV + tumors were associated with high-grade tubular/papillary morphology and GS tumors were associated with poorly cohesive/mixed type, while tumors in the MSI group were associated with low-grade tubular/papillary morphology (p < .0001). Marked tumor budding was the least in MSI tumors and the most in GS tumors (p = .018). The longest survival time was in the patients of EBV + group, while the shortest survival time was in the patients of GS group (p = .029). Cox regression analysis indicated that age, lymphovascular invasion, positive surgical margins, low-grade tubular and papillary histological types, two groups within molecular- like classification (MSI and GS) were independent prognostic factors (p < .05). Conclusion: Molecular-like classification holds promise as a low-cost, easy-to-implement classification that can be used predictively in prognosis. However, molecular-based studies with large series are still needed to determine whether it is a pretest or alternative of molecular classifications.

Background/Objectives: Claudin-18.2 (CLDN18.2) has recently emerged as a therapeutic target in gastric cancer; however, its prognostic relevance in the neoadjuvant setting remains insufficiently defined. We evaluated the clinical significance of CLDN18.2 and fibroblast growth factor receptor 2b (FGFR2b) expression in patients with locally advanced gastric cancer treated with neoadjuvant therapy. Methods: This retrospective single-center study included 64 patients with locally advanced gastric cancer who received neoadjuvant chemotherapy followed by curative surgery. Pretreatment endoscopic biopsy specimens were analyzed using immunohistochemistry to assess CLDN18.2 and FGFR2b expression. Survival outcomes were evaluated using Kaplan-Meier analysis and Cox proportional hazards regression models. Results: CLDN18.2 positivity was detected in 29.7% of patients and was not associated with baseline clinicopathological characteristics or pathological treatment response. However, CLDN18.2-positive tumors demonstrated significantly shorter relapse-free survival (median 19.0 vs. 36.6 months, p = 0.038) and overall survival (median 28.9 vs. 53.4 months, p = 0.005). In multivariable analysis, CLDN18.2 positivity remained an independent predictor of relapse-free survival. FGFR2b positivity was observed in 14.1% of patients and was evaluated descriptively due to limited case numbers. Conclusions: CLDN18.2 expression may represent a clinically relevant prognostic biomarker reflecting aggressive tumor biology in locally advanced gastric cancer treated with neoadjuvant therapy.

Background: Human epidermal growth factor receptor 2 (HER2) alterations have been implicated as mechanisms of resistance to anti-epidermal growth factor receptor (anti-EGFR) therapy in metastatic colorectal cancer (mCRC). We aimed to evaluate the predictive and prognostic significance of HER2 expression in patients with RAS wild-type mCRC in a real-world setting. Methods: We conducted a multicenter retrospective cohort study across ten oncology centers in Turkey, including patients with RAS wild-type mCRC treated between 2015 and 2022. Clinical outcomes, including progression-free survival (PFS) and overall survival (OS), were compared between HER2-positive and HER2-negative groups. Multivariable Cox proportional hazards models were used to identify independent predictors of survival outcomes. Results: Among 204 patients, 28 (13.7%) were HER2-positive. Baseline characteristics were generally comparable; however, HER2-positive patients showed a trend toward higher-grade tumors and were significantly less likely to receive anti-EGFR therapy. HER2-positive patients had significantly shorter PFS compared to HER2-negative patients (median 10 vs. 13 months; p = 0.006). In multivariable analysis, HER2 positivity remained an independent predictor of shorter PFS (HR 1.76, 95% CI 1.01-3.07; p = 0.045). In the subgroup of 144 patients receiving anti-EGFR therapy, HER2-positive patients also demonstrated significantly shorter PFS (median 9.0 vs. 14.0 months; p = 0.023). No significant differences in OS were observed between groups. Conclusions: HER2 positivity is associated with reduced response to anti-EGFR therapy and independently predicts shorter PFS in patients with RAS wild-type mCRC. These findings further support the role of HER2 as a clinically relevant biomarker in RAS wild-type mCRC, particularly in predicting response to anti-EGFR therapy, while highlighting the need for optimized patient selection strategies in the era of HER2-targeted treatments.

Solid pseudopapillary neoplasms (SPNs) are rare pancreatic tumors that are indolent but occasionally present with metastatic or locally invasive disease. Although recurrent CTNNB1 exon 3 mutations define their molecular background, the clinicopathological and molecular features associated with these less common presentations remain incompletely characterized. This retrospective study included 62 patients diagnosed with SPN between 2000 and 2025. Clinicopathological and immunohistochemical features, including β-catenin, progesterone receptor (PR), androgen receptor (AR), and BAP1, were evaluated. Targeted sequencing was performed in a subset of cases with metastatic or locally invasive disease (n = 5). Patients showed a wide age range (8-71 years), female predominance (54/62, 87.1%), and a mean tumor size of 7.2 cm. Lymphovascular invasion was rare (1/59, 1.7%). Metastatic or locally invasive SPNs (n = 8) more frequently showed higher Ki-67 values (median, 5%; range, 1%-15%), increased mitotic activity (2/8, 25%), and capsular/parenchymal invasion (6/8, 75%), while perineural invasion was absent. All tumors demonstrated nuclear β-catenin expression, with PR and AR positivity (50/59, 84.7% and 47/57, 82.5%, respectively). PR expression was higher in AR-positive cases (43/47, 91.5% vs. 6/10, 60%). BAP1 loss was identified in 13/57 cases (22.8%). Targeted sequencing consistently identified CTNNB1 exon 3 mutations. Additional low-frequency molecular alterations affecting genes involved in cell cycle regulation, chromatin remodeling, and signaling pathways, including CDKN2A and BAP1, were observed. During a mean follow-up of 97.2 months, distant metastasis occurred in 4/62 patients (6.5%) and locally invasive disease in 4/62 (6.5%), with an overall survival rate of 95%. Overall, these findings highlight the biological heterogeneity of SPNs and indicate that, despite a shared molecular background, aggressive behavior is not defined by a single reproducible pathological or molecular feature.

BACKGROUND:This study investigated the relationship between circulating tumor DNA (ctDNA) parameters and metabolic parameters from FDG PET/CT in advanced breast cancer (ABC) patients. METHODS:In this retrospective single-center study, 47 ABC patients who underwent both liquid biopsy and FDG PET/CT were analyzed. RESULTS:Results showed that 27 patients (57.4%) had detectable ctDNA. Patients with detectable ctDNA demonstrated significantly higher whole-body metabolic tumor volume (WB-MTV) (p = 0.002) and whole-body total lesion glycolysis (WB-TLG) (p = 0.006) compared to those without ctDNA, while no significant difference was found in SUVmax or SUVmean. A moderate correlation was observed between variant allele frequency (VAF) values and metabolic parameters: maximum VAF correlated with SUVmax, WB-MTV, and WB-TLG (r = 0.407, p = 0.005; r = 0.457, p = 0.001; r = 0.415, p = 0.004, respectively). Mean VAF correlated with SUVmax, WB-MTV, and WB-TLG (r = 0.406, p = 0.005; r = 0.446, p = 0.002; r = 0.404, p = 0.005, respectively). The total VAF correlated with SUVmax, WB-MTV, and WB-TLG (r = 0.394, p = 0.006; r = 0.465, p = 0.001; r = 0.430, p = 0.003, respectively). When excluding patients without detectable ctDNA, the correlation between VAF values and WB-MTV, WB-TLG disappeared, while the correlation with SUVmax persisted. Total alteration number in ctDNA showed a moderate correlation with WB-MTV and WB-TLG (r = 0.563, p < 0.001; r = 0.459, p = 0.001, respectively). Correlation with WB-MTV remained significant when excluding patients without detectable ctDNA (r = 0.500, p = 0.008). CONCLUSIONS:These findings suggest that metabolic tumor burden correlates with ctDNA detection and characteristics, potentially offering complementary information for disease monitoring, treatment selection, and response assessment in ABC. The combined use of these parameters may improve prognostic evaluation and guide personalized treatment strategies.

OBJECTIVE:The relationship between the number of lymph nodes removed and survival was investigated in patients undergoing radical gastrectomy and D2 lymph node dissection for gastric cancer. METHODS:Patients who underwent gastrectomy and D2 lymph node dissection were analyzed. The cases were evaluated based on age, sex, tumor stage, number of removed lymph nodes, operation duration, presence of comorbidities, tumor status at the surgical margin, lymphovascular invasion, and perineural invasion. Survival analyses at 1 and 3 years were conducted. RESULTS:The 1-year survival rate was 73%, and the 3-year survival rate was 40.4%. Factors associated with 1-year survival included age ≥70 years, the number of removed lymph nodes <35, and the presence of lymphovascular invasion, which negatively impacted survival. Age ≥70 years reduced survival by 3.7 times, the number of lymph nodes removed <35 reduced survival by 3.3 times, and the presence of lymphovascular invasion reduced survival by 4.6 times. For 3-year survival, age affected survival by 4.1 times, and tumor presence at the surgical margin affected survival by 2.85 times. A positive correlation was found between the number of removed lymph nodes and survival (p=0.006). CONCLUSION:Lymph node dissection should be performed according to guidelines, and efforts should be made to increase the number of removed lymph nodes.

Objective: Thyroid nodules are common and prevalence is 19-68% in the population. The gold standard diagnosis is fine needle aspiration cytology (FNAC). In this study, we examined the sonographic features of thyroid nodules with IV, V, VI [malignant cytology, malignancy suspected cytology (MC-MSC), and follicular neoplasia (FN)] according to the Bethesda Thyroid Cytopathology Reporting System (BTCRS). We aimed to evaluate its correlation with the American College of Radiologists' (ACR) Thyroid Imaging Reporting and Data System (TIRADS) classification. Methods: Ultrasound (US) features of 198 nodules detected as IV, V, and VI according to BTCRS in FNAC results were retrospectively examined. They were classified according to the ACR-TIRADS categorization from 1 to 5. Results: Of the 198 nodules, 153 were in MS-MSC and 45 were in FN. Female/male ratio; 155/43 and the mean age was 48.8+-13.1. The mean size of the nodules was 18.7+-9.3 mm. The mean size was 21.2+-9.2 mm in the FN group and 18+-9.3 mm in the MS-MSC group. Nodule size was found to be statistically significant in the FN group (p=0.013). The TIRADS score was found to be higher in the MS-MSC group (p=0.041). Ninety-three percent of the FN group and 92% of the MS-MSC group were based on a single nodule. Conclusion: TIRADS helps determine the malignant potential of thyroid nodules and prevent unnecessary biopsies. The presence of a single nodule may be a significant finding in malignancy. US features of follicular thyroid carcinoma may differ from typical TIRADS criteria, and size is a significant finding in distinguishing it from papillary thyroid carcinoma.

Objectives:This study aimed to investigate ultrasound (US) features of thyroid nodules categorized as nondiagnostic (ND) and atypia of undetermined significance (AUS) according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and their potential implications for clinical management.Materials and Methods:A retrospective study was conducted on patients who underwent thyroid nodules FNAC between 2019 and 2023. Nodules falling into the ND and AUS categories were analyzed for US features, nodule size, composition, echogenicity, shape, margin, echogenic foci, the distribution of the American College of Radiology's Thyroid Imaging Reporting and Data System (ACR TI-RADS) categories, and other parameters. The study included a total of 1,199 patients and 1,252 nodules (ND: 1110; AUS: 142).Results:No significant differences in age, gender, nodule features, echogenicity, shape, margin, echogenic foci, TI-RADS scores, localization, number of nodules, or thyroid parenchymal disease presence were found between the ND and AUS categories (p > 0.05). Also, no statistically significant difference in nodule size (<10 mm vs. ≥10 mm) existed between the ND and AUS categories (p = 0.475). Both showed predominantly solid composition and hyperechoic/isoechoic echogenicity. High proportions of TI-RADS 4 nodules were observed in both groups, with 727 (65.5%) in ND and 95 (66.9%) in AUS.Conclusion:This study found no statistically significant differences in US characteristics between the ND and AUS categories, indicating potential similarities in their radiological appearances. Also, no significant difference in nodule size (<10 mm and ≥10 mm) was observed between these categories. Clinical management should consider further investigations, including repeat FNAC, due to the diagnostic challenges and malignancy risk in both categories.

Aim: In this study, it was aimed to investigate the prognostic importance of Tumor budding (TB) in Pancreatic ductal adenocarcinomas(PDAC) and its correlation with histopathological findings according to the International Tumor Budding Consensus Conference(ITBCC) grading. Material and Methods: A total of 75 patients diagnosed with PDAC were included in this study. The demographic features of the cases (age, sex) and the macroscopic features of the tumors (localization,size) were obtained from the electronic archive system. All Hematoxylin-Eosin-stained sections were re-evaluated in terms of differentiation, presence of lymphovascular (LVI) and perineural invasion(PNI), surgical margin positivity, primary tumor(pT), lymph node metastasis(LNM) and tumor budding. Statistically, Chi-square test, cox-regression and Kaplan-Meier test were performed. Results:Thirty four of the cases were female and 41 were male. The mean age was 64.21±9.71years. The degree of TB was TB-few in 17 cases, TB-moderate in 25cases, and TB-high in 33cases. LVI, PNI, LNM and TB-high were poor prognostic factors. Moreover, TB-high was related with poor differantiation,LVI,PNI,LNM and short survival time. Tumor budding was independent negative prognostic factor in multivariable model analyzes. Conclusion: ITBCC scoring can also be used in PDACs. In addition, high tumor budding was a poor prognostic feature and might be a target for tumor-specific treatments as it could be a predictive finding for the locally invasive character of the tumor. Evaluation and grading of TB thought to represent EMT may be a histological feature that can be used in tumor selection for advanced molecular methods to identify subtypes that may be associated with poor prognosis and drug resistance.

Aim In this prospective study, the efficiency of imaging findings was investigated by comparing the histopathological results of lymph nodes with Doppler and ultrasound features and elasticity scores.Material and method A total of 100 cervical or axillary lymph nodes with a suspected malignancy or whose size did not decrease after treatment were examined. In addition to the demographic data of the patients, B-mode ultrasound, Doppler ultrasound, and elastography features of the lymph nodes were evaluated prospectively. The irregular shape, increased size, pronounced hypoechogenicity, presence of micro/macro calcification, short axis/long axis ratio > 2, increased size of the short axis, increased cortex thickness, obliterated hilus or increased cortex thickness > 3.5 mm were evaluated on ultrasound. Resistivity index, pulsatility index, acceleration rate and time were evaluated for intranodal arterial structures on color. Doppler ultrasound, strain ratio value and elasticity score were recorded on ultrasound elastography. After sonographic examination, patients underwent ultrasound-guided fine needle aspiration cytology or trucutting needle biopsy. Histopathological examination results of the patients were compared with the B-mode ultrasound, Doppler ultrasound, and ultrasound elastography.Results When the individual and combined effects of the ultrasound, Doppler ultrasound, and ultrasound elastography were evaluated, the combination of all three imaging methods was found to have the highest sensitivity and the highest overall accuracy (90.4% and 73.9%). As an individual method Doppler ultrasound had the highest specificity (77.8%). B-mode ultrasound was found to have the lowest accuracy (56.7%) both in individual and combined evaluations.Conclusion Addition of ultrasound elastography to the combination of B-mode and Doppler ultrasound findings increases diagnostic sensitivity and accuracy in the differentiation of benign and malignant lymph nodes.

Introduction and Aim: Pancreas Ductal Adenocarcinomas (PDACs) are among the leading causes of cancer-related death. Tyrosine kinase receptors (TKRs) are responsible for cell plasticity, chemoresistance, immunosuppression and metastasis potential. Axl is a receptor of the TKR family, and it has come to the fore in cancer treatment in the last decade. This study aimed to investigate the relationship of immunohistochemical Axl expression with histological features and its prognostic importance in PDACs. Materials and Methods: Fifty-three patients who were operated on for PDAC between 2006-2017 were evaluated retrospectively. Features of tumors; size, lymphovascular invasion (LVI), perineural invasion (PNI), resection margin (RM), lymph node metastasis (LNM), differentiation, tumor-infiltrating lymphocyte, stage and overall survival were recorded. Immunohistochemically, membranous and or cytoplasmic staining was considered positive for Axl. Statistically, Pearson Chi-Square, Cox regression and Kaplan Mayer tests were used in the SPSS 21.0 program. Results: Axl was positive in 28 patients (52.8%). Axl positivity was found to be associated with the presence of LVI (P = 0.009) and LNM (P = 0.002) and was an independent prognostic factor in short survival (P = 0.006). Conclusion: It was found that increased expression of Axl, which is known to increase EMT-mediated metastasis in carcinogenesis, may be an indicator of local spread and poor prognosis in PDAC patients. In this respect, it can be promising as a targeted molecule in PDAC patient's individualized treatments.

OBJECTIVE Magnesium is considered as potential neuroprotective and therapeutic agent, but certain studies have provided evidence of its apoptotic effectiveness in neurons. We aimed to evaluate the possible apoptotic effects of long-term magnesium use in healthy adult rat brains. MATERIALS AND METHODS Magnesium citrate and magnesium glycinate compounds were administered orally to rats for 8 weeks (36 mg/kg). Expression levels of Bcl-2, Bax and Cyt-C genes were analyzed by real-time polymerase chain reactions (RT-PCR) in the prefrontal cortex, hippocampus and striatum regions. Bcl-2, Bax and CytC protein levels were measured using ELISA kits. Tissue sections were evaluated histopathologically with hematoxylin-eosin staining. RESULTS Compared to the control group, the magnesium-administered groups indicated gene expression reductions in almost all brain regions; pro-apoptotic Bax, anti-apoptotic Bcl-2 and Cyt-C gene expression levels were reduced. With magnesium, the Bcl-2 and Bax protein levels were increased. Bax/Bcl-2 gene and protein ratio were also increased in the striatum and hippocampus, whereas Cyt-C protein levels were decreased or did not change in the magnesium treated groups. There was no pathological finding in histological evaluation. CONCLUSIONS Long-term magnesium usage can promote apoptotic cascade in brain tissue by increasing Bax/Bcl-2 ratio. Cyt-C, a prominent factor processing caspase pathway, was decreased or unchanged. In addition, taking into account the histological evaluation, we supposed that the absence of Cyt-C in the cytosol can prevent the subsequent apoptotic pathway. Consequently, we obtained the findings of apoptotic initiation with magnesium in brain, but this cascade seems to be arrested at later stages.

Background:Tumor budding is a histopathological finding that is accepted as an indicator of epithelial-mesenchymal transformation in many solid tumors. Axl is a Receptor Tyrosine Kinase (RTK) family member and contributes to epithelial-mesenchymal transformation. It has been reported that its overexpression in various solid cancer cells is associated with a poor prognosis. It is claimed that Axl RTK may be the targeted molecule in treating some cancers due to its location in the cell membrane.Aims:To investigate the relationship between immunohistochemical (IHC) Axl expression with tumor budding on the histopathological level and their prognostic significance in patients with gallbladder carcinoma. Thus, it is aimed to contribute to the emergence of a molecular option for targeted, personalized therapy in these patients.Study Design:A retrospective cross-sectional study.Methods:Thirty-eight gallbladder cancer patients who underwent surgery between 2000 and 2017 were included in the study. The expressions of Axl RTK in tumor tissues were evaluated by the IHC method. Demographic data (age, sex) of patients, histopathological features (size, growth pattern), tumor differentiation, pathological T staging, lymphovascular invasion, perineural and serosal invasion, surgical margin, tumor infiltrated lymphocyte, and tumor budding were examined. The tumor budding of the tumor was made according to the International Tumor Budding Consensus Conference and was classified as low (0-4 buds), intermediate (5-9 buds), high (≥ 10 buds). The relationship between clinical pathologic features, the survival rate, and Axl expression was analyzed with Person’s chi-square, Cox regression tests, and the Kaplan-Meier method.Results:Tumor budding was determined as low in 12, intermediate in 10, and high in 16 cases. The increased degree of tumor budding was associated with focal-diffuse Axl expression (p = 0.018), infiltrative growth patterns (p = 0.031), poor differentiation (p = 0.006), advanced pathological stage (p = 0.002), and serosal (p = 0.040), perineural (p = 0.008), and lymphovascular invasion (p < 0.0001). Overall survival time was shorter in patients with intermediate to high tumor budding compared with those with low tumor budding (p = 0.011).Conclusion:Axl expression appears to be associated with tumor budding capacity, which may be a poor prognostic criterion for patients with gallbladder cancer. It may be a good target to prevent tumor budding to reduce tumor invasion and metastasis.

Ectopic liver is defined as the presence of normally organized liver tissue outside its normal location. It is frequently found in the gallbladder. Ectopic liver is normally as- ymptomatic and only discovered incidentally. We report a case of 51- year- old wom- an with ectopic liver and we also review the characterization of this rare entity .This report adds another case to the very rarely reported ectopic liver located in the gall- bladder.

A comprehensive molecular classification was published in 2014 within The Cancer Genome Atlas (TCGA) to guide clinical approaches and treatment strategies. This study aimed to investigate the clinicopathological and prognostic importance of the classification using immunohistochemistry (IHC) and chromogenic in situ hybridization (CISH) to identify potential surrogate markers of molecular changes in gastroesophageal junction (GEJ) adenocarcinomas. A total of 52 GEJ adenocarcinomas were divided into five groups using IHC with MLH-1, E-cadherin, p53 and CISH with EBER: 1) microsatellite unstable (MSI: negative with MLH-1), 2) genomically stable tumors (GS: positive with p53), 3) chromosomally unstable tumors (CUN: negative with e-cadherin), 4) EBV+ tumors (EBV+: positive with EBER) and 5) unclassifiable (G-NOS: MLH-1 and e-cadherin positive with p53 and negative with EBER). The largest group consisted of 24 (46.2%) cases of CUN tumors. This group was followed by groups of GS with 14 (26.9%) cases, MSI with 7 (13.5%) cases, and EBV + with 3 (5.8%) cases, respectively. Although this classification was not associated with pathological features, it was found to be closely related to prognosis (p = 0.029). Patients with EBV+ tumors had the longest overall survival, followed by the G-NOS, MSI, CUN, GS groups.

Hepatocellular carcinomas (HCCs) with steatohepatitis and steatosis are reported with varying definitions and clinicopathologic features. We aimed to search the attributes of steatohepatitic hepatocellular carcinoma (SH-HCC) and steatotic-HCC in our series. A retrospective clinicopathologic analyses of 150 HCCs and immunostaining for C-reactive protein (CRP) and serum amyloid A (SAA) were performed. Tumors were reclassified as all SH-HCC, limited SH-HCC, typical SH-HCC (steatohepatitic features in >5%, 5% to 50%, and ≥50% of the tumor, respectively), steatotic-HCC, and classic HCC (C-HCC). Group comparisons were made using Kruskal-Wallis and Kaplan-Meier tests. The background etiology in all SH-HCCs was pure viral in 51.4%, nonalcoholic steatohepatitis (NASH)/alcoholic liver disease (ALD) alone/mixed in 34.3%, and unidentified in normal liver in 14.3%. All SH-HCCS (n=35, 23.3%) and typical SH-HCCs (n=13, 8.6%) had higher NASH/ALD. Limited SH-HCCs (n=22, 14.6%) had higher ALD (all P<0.05). Typical SH-HCCs tended to have more NASH (P=0.054). Steatotic-HCCs (n=13, 9%) and C-HCCs (n=102, 68%) had higher pure viral etiology and serum CRP (all P<0.05). CRP and SAA were positive in 69% and 27% of the tumors, respectively. SAA positivity correlated with ALD (P=0.026). In the overall group disease-free survival rates at 1, 5, 10, and 20 years were 97.0%, 82.3%, 79.6%, and 77.2%, respectively. Demographics, tumor characteristics, CRP and SAA positivity, and survival were similar between the groups (P>0.05). SH-HCC is heterogenous in terms of underlying etiologies, and can be seen in NASH/ALD, pure viral and noncirrhotic/normal background. The ≥50% cutoff for the definition of SH-HCC can lead to overlook ALD-related SH-HCC. Steatotic-HCC seems more similar to C-HCC rather than SH-HCC, but none of them feature as a different prognostic group.

Hepatocellular carcinomas (HCCs) with steatohepatitis and steatosis are reported with varying definitions and clinicopathologic features. We aimed to search the attributes of steatohepatitic hepatocellular carcinoma (SH-HCC) and steatotic-HCC in our series. A retrospective clinicopathologic analyses of 150 HCCs and immunostaining for C-reactive protein (CRP) and serum amyloid A (SAA) were performed. Tumors were reclassified as all SH-HCC, limited SH-HCC, typical SH-HCC (steatohepatitic features in >5%, 5% to 50%, and ≥50% of the tumor, respectively), steatotic-HCC, and classic HCC (C-HCC). Group comparisons were made using Kruskal-Wallis and Kaplan-Meier tests. The background etiology in all SH-HCCs was pure viral in 51.4%, nonalcoholic steatohepatitis (NASH)/alcoholic liver disease (ALD) alone/mixed in 34.3%, and unidentified in normal liver in 14.3%. All SH-HCCS (n=35, 23.3%) and typical SH-HCCs (n=13, 8.6%) had higher NASH/ALD. Limited SH-HCCs (n=22, 14.6%) had higher ALD (all P<0.05). Typical SH-HCCs tended to have more NASH (P=0.054). Steatotic-HCCs (n=13, 9%) and C-HCCs (n=102, 68%) had higher pure viral etiology and serum CRP (all P<0.05). CRP and SAA were positive in 69% and 27% of the tumors, respectively. SAA positivity correlated with ALD (P=0.026). In the overall group disease-free survival rates at 1, 5, 10, and 20 years were 97.0%, 82.3%, 79.6%, and 77.2%, respectively. Demographics, tumor characteristics, CRP and SAA positivity, and survival were similar between the groups (P>0.05). SH-HCC is heterogenous in terms of underlying etiologies, and can be seen in NASH/ALD, pure viral and noncirrhotic/normal background. The ≥50% cutoff for the definition of SH-HCC can lead to overlook ALD-related SH-HCC. Steatotic-HCC seems more similar to C-HCC rather than SH-HCC, but none of them feature as a different prognostic group.