Background: Hepatocellular carcinoma (HCC) remains a major health problem despite the emergence of several
preventive and therapeutic modalities. HCC has heterogeneous and wide morpho-molecular patterns, resulting in
unique clinical and prognostic criteria. Therefore, we aimed to study the clinical and pathological criteria of HCC to
update the morpho-molecular classifications and provide a guide to the diagnosis of this disease.
Methods: Five hundred thirty pathologically analyzed HCC cases were included in this study. The clinical and survival
data of these cases were collected.
Results: Hepatitis C virus is still the dominant cause of HCC in Egypt. Post-direct-acting antiviral agent HCC showed
an aggressive course compared to interferon-related HCC. Old age, male gender, elevated alpha-fetoprotein level,
tumor size, and background liver were important prognostic parameters. Special HCC variants have characteristic
clinical, laboratory, radiological, prognostic, and survival data. Tumor-infiltrating lymphocytes rather than neutrophilrich
HCC have an excellent prognosis.
Conclusions: HCC is a heterogenous tumor with diverse clinical, pathological, and prognostic parameters. Incorporating
the clinicopathological profile per specific subtype is essential in the treatment decision of patients with HCC.
Trial registration: This was a retrospective study that included 530 HCC cases eligible for analysis. The cases were
obtained from the archives of the Pathology Department, during the period between January 2010 and December
2019. Clinical and survival data were collected from the patients’ medical records after approval by the institutional
review board (IRB No. 246/2021) of Liver National Institute, Menoufia University. The research followed the guidelines
outlined in the Declaration of Helsinki and registered on ClinicalTrials.gov (NCT05047146).