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Table 1 Histological features according to Edmondson and Steiner (ES) and WHO classification

From: The current role and future prospectives of functional parameters by diffusion weighted imaging in the assessment of histologic grade of HCC

Classification Grades Architecture Cytology Other features
Edmondson and Steiner I Areas of carcinoma where distinction from hyperplastic liver is difficult
II Trabecular, frequent acini (lumen varying from tiny canaliculi to large thyroid-like spaces) Resemblance to normal hepatic cells; larger nuclei; abundant acidophilic cytoplasm Cell borders sharp and clear cut; acini containing bile or protein precipitate
III Distortion of trabecular structure, acini less frequent than grade II Larger, more hyperchromatic nuclei, granular but less acidophilic cytoplasm Acini are less frequent; tumor giant cells may be numerous
IV Medullary, less trabeculae, rare acini Highly hyperchromatic nuclei, scanty cytoplasm, with fewer granules Loss of cell cohesiveness; giant, spindle or short-plump cells can be found
World Health Organization Well differentiated Thin trabecular, frequent acinar structures Minimal atypia Fatty change is frequent
Moderately differentiated Trabecular (3 or more cells in thickness) and acinar Abundant eosinophilic cytoplasm, round nuclei with distinct nucleoli Bile or proteinaceous fluid within acini
Poorly differentiated Solid Moderate to marked pleomorphism Absence of sinusoid-like blood spaces
Undifferentiated Solid Little cytoplasm, spindle, or round-shaped cells