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Les lésions précancéreuses sur foie cirrhotique et non cirrhotique

Precancerous lesions on cirrhotic and non cirrhotic liver

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Conclusion

Le CHC se développe sur des terrains bien particuliers; certains sont connus: cirrhose, hépatite chronique, surcharge en fer avec ou sans fibrose, stéatose, adénome; d’autres sont encore inconnus. Par une meilleure connaissance des terrains prédisposants et des lésions prénéoplasiques (lésions microscopiques ou nodules macroscopiques), il sera possible, grâce à la biologie moléculaire si possible dans le sang [27–28], de posséder des arguments sur le potentiel malin du nodule ou du foie en général, sur l’agressivité potentielle de la tumeur et sur la réponse thérapeutique aux nouvelles molécules. A côté de l’imagerie qui détectera de façon de plus en plus fiable des nodules de taille inférieure au cm, une place majeure sera accordée à la qualité et à la conservation des prélèvements tissulaires. Grâce aux nouvelles technologies, le foie et le sang vont certainement fournir des données encore insoupçonnées qu’il faudra prendre en compte pour le suivi et le traitement du CHC. Dans l’attente de ces résultats, il nous faut adopter une attitude pragmatique pour dépister le plus tôt possible les patients à haut risque de développer un CHC susceptible de bénéficier d’un traitement curateur [1].

Conclusion

HCC develops in specific grounds, some of them being well known: cirrhosis, chronic hepatitis, iron overload with or without fibrosis, steatosis, adenoma; others are still unknown. For a better knowledge of the predisposing factors and of preneoplastic lesions (microscopic lesions of macroscopic nodules), blood study by molecular biology [21, 28]will provide arguments concerning the malignant potential of the nodule or more generally of the liver, on the potential malignancy of the tumour and the therapeutic response to new molecules. Beside imaging studies which in the future will allow for detecting more and more accurately nodules inferior to 1 cm, a major place will be dedicated to the quality of conservation of tissue samples. The new emerging technologies will probably allow for obtaining still unsuspected data in liver and blood which will be of uttermost importance for the follow-up and therapeutic approach of HCC. Before reaching these results, a pragmatic attitude should be adopted to detect as soon as possible the HCC high risk patients susceptible to benefit from a curative treatment [1].

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Correspondence to Ch. Balabaud.

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Blanc, J.F., Bioulac-Sage, P. & Balabaud, C. Les lésions précancéreuses sur foie cirrhotique et non cirrhotique. Acta Endosc 36, 325–334 (2006). https://doi.org/10.1007/BF03006039

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Mots-clés

  • cirrhose
  • foie
  • lésions précancéreuses

Key-words

  • cirrhosis
  • liver
  • precancerous lesions