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目的：探讨何为肝细胞癌（ＨＣＣ）的癌前病变以及这种病变的形成和发展．方法：对３７９例肝标本进行了形态学观察和ｃ－ｍｙｃ，ｃ－ｅｒｂＢ－２，ＩＧＦⅡ，表皮生长因子（ＥＧＦ）受体、乙型肝炎病毒（ＨＢＶ）抗原及增殖细胞核抗原（ＰＣＮＡ）的免疫组织化学研究．结果：大细胞性不典型增生（ＬＣＤ）在癌旁肝内的程度并不高于非癌旁肝，不能大量表达ＩＧＦⅡ，ｃ－ｅｒｂＢ－２及ＨＢＶＸ基因，具有较抵的细胞增殖活性，这不支持ＬＣＤ是癌前病变的假说；小管状化生（ＤＭ）的肝细胞较大量表达ｃ－ｅｒｂＢ－２但ＩＧＦⅡ表达水平较低，具有略高于增生胆小管的细胞增殖活性，这提示ＤＭ是一种修复性增生；肝小多角细胞（ＳＰＬＣ）和小细胞性不典型增生（ＳＣＤ）仅见于慢性肝脏病变，但前者远早于和多于后者，ＳＣＤ在癌旁肝中的程度远强于非癌旁肝，大量表达ＩＧＦⅡ，ｃ－ｅｒｂＢ－２和ＨＢｘＡｇ，并具有仅次于ＨＣＣ而高于其它细胞类型的细胞增殖活性．结论：ＳＣＤ可能是真正的癌前病变，它可能由显著的ＳＰＬＣ增生转化而来，与ＨＢｘＡｇ表达及ＩＧＦⅡ，ｃ－ｅｒｂＢ－２等ＨＣＣ相关基因的激活有关．
Objective: To investigate what is the precancerous lesion of hepatocellular carcinoma (HCC) and the formation and development of this lesion. Methods: 379 cases of liver specimens were observed morphologically and the expressions of c-myc, c-erbB-2, IGFⅡ, epidermal growth factor receptor, hepatitis B virus antigen and proliferating cell nuclear antigen (PCNA) Immunohistochemistry. Results: The expression of large cell dysplasia (LCD) in noncancerous liver was not higher than that in non-paracancer liver. It could not express IGF Ⅱ, c-erbB-2 and HBVX gene in large amount, Lack of support for the hypothesis that LCD is a precancerous lesion; small tubular metaplasia (DM) hepatocytes express c-erbB-2 in relatively large quantities but lower IGF II expression, with a slightly higher proliferative activity than proliferating tubule DM is a form of reparative hyperplasia; small polygonal cells (SPLC) and small cell dysplasia (SCD) are only found in chronic liver disease, but the former is far and more than the latter, the degree of SCD in the paracancer liver Far stronger than non-paracancerous liver, and abundantly expressed IGFⅡ, c-erbB-2 and HBxAg, and had cell proliferation activity higher than that of other cell types after HCC. Conclusion: SCD may be a true precancerous lesion. It may be transformed by significant SPLC hyperplasia and is related to the expression of HBxAg and the activation of HCC related genes such as IGF Ⅱ and c-erbB-2.