Rom J Morphol Embryol 2012, 53(3 Suppl):677–682 ISSN (print) 1220–0522 ISSN (on-line) 2066–8279 ORIGINAL PAPER Histological aspects of post-TACE hepatocellular carcinoma CORINA GABRIELA COTOI 1,2) , SHIRIN ELIZABETH KHORSANDI 2) , I. E. PLEŞEA 1) , A. QUAGLIA 2) 1) Department of Pathology, University of Medicine and Pharmacy of Craiova, Romania 2) Institute of Liver Studies, King’s College Hospital, London, UK Abstract Hepatocellular carcinoma (HCC) is the fifth most common type of cancer in men and the seventh in women and is the third most common cause of death from cancer worldwide [http://globocan.iarc.fr]. The overall incidence of HCC remains high in developing countries and is steadily rising in most industrialized countries [Shariff MI et al., 2009]. A variety of therapeutic modalities is available for treating hepatocellular carcinoma, but orthotopic liver transplantation (OLT) represents a curative option. Due to the shortage of donor organs and the increasing need for liver transplantation in the last decade, local ablation therapy (LAT) has been increasingly used in many centers as a bridge to transplant [Majno PE et al., 1997; Decaens T et al., 2005; Herber S et al., 2005; Bharat A et al., 2006; Obed A et al., 2007; Otto G et al., 2007]. We retrieved from the archive in the Histopathology Laboratory, Institute of Liver Studies, King’s College Hospital, London, UK, 28 cases of HCC, which underwent treatment with TACE (Doxorubicin 40 mg/m 2 ) as a bridge to transplantation, between 2008 and 2010. We also analyzed 14 additional post-TACE tumors, classified according to the architectural patterns published by Morisco F et al. (2008), for quantification of necrosis. Extensive tumor necrosis was observed in 12 (42.85%) of the patients. Viable hepatocellular carcinoma showed a wide range of differentiation, from well to poorly differentiated. The phenotype of the tumors was mostly hepatocelluar, but 14% showed a mixed phenotype, including glandular/pseudoglandular formation and cholangiocellular components. The percentage of necrosis ranged between 0% and 100%, with an average of 50.6%. There was no statistical correlation between the total size of the nodules and the surface of necrosis in our series (p=0.125). In conclusion, the systematic pathological assessment of post-TACE resected HCC can help in investigating the biology of treated tumors but needs to incorporate sampling protocols, digital image analysis, phenotypic classification by immunohistochemistry and enzymatic function. Keywords: hepatocellular carcinoma, TACE, laser microdissection, necrosis.  Introduction Hepatocellular carcinoma (HCC) is the fifth most common type of cancer in men and the seventh in women and is the third most common cause of death from cancer worldwide [1]. The overall incidence of HCC remains high in developing countries and is steadily rising in most industrialized countries [2]. It is long known that the major clinical risk factor for HCC is liver cirrhosis, largely independent of its etiology [3, 4]. A variety of therapeutic modalities is available for treating hepatocellular carcinoma (HCC), but orthotopic livertransplantation (OLT) represents the only curative option. Through OLT, both the tumor and the under- lying cirrhosis can be cured [4–6]. Due to the shortage of donor organs and the increasing need for liver transplantation in the last decade, local ablation therapy (LAT) has been increasingly used in many centers as a bridge to transplant [7–14]. Of all the different LAT modalities, trans-arterial chemoembolization (TACE) is the treatment of choice in many centers because it exploits the predominant arterial supply to HCC and combines ischemic injury with chemotherapeutic toxicity [15]. Besides downstaging patients, the most important goal of TACE in transplant candidates is to keep them in a steady state and to avoid dropout from the transplant list [9–13]. TACE efficacy is usually assessed by imaging and monitoring tumor markers [15, 16]. Complete response is achieved in fewer than 2% of patients, the rate of objective response ranging from 16% to 60% [17]. The effect of TACE or other modalities of local ablation therapy on treated tumors can also be evaluated at tissue level when the whole liver is subsequently removed at transplantation [18].  Materials and Methods We retrieved from the archive in the Histopathology Laboratory, institute of Liver Studies, King’s College Hospital, London, UK, 28 cases of HCC which underwent treatment with TACE (Doxorubicin 40 mg/m 2 ) followed by transplantation, between 2008 and 2010. The characteristics of the patients (i.e., age, sex, and underlying chronic liver diseases) are summarized in Table 1. Before the TACE treatment, all nodules were radiologically diagnosed to be HCC according to the European Association for the Study of the Liver criteria [17] for concordant imaging of nodular arterialized lesions with portal venous washout. R J M E Romanian Journal of Morphology & Embryology http://www.rjme.ro/