HCC Histologic Grading
AJCC 8th edition 4-tier hepatocellular carcinoma grade, with support for documenting alternative systems.
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Histologic grade has been shown to relate to tumor size, presentation, and metastatic rate, and is an independent predictor of outcome in many studies. This tool is a documentation aid only and does not replace professional pathologist judgment, institutional protocols, or the current edition of the applicable grading system.
Reference
AJCC 8th edition — full criteria
| Grade | Differentiation | Key features |
|---|---|---|
| G1 | Well-differentiated | Closely resembles normal liver; minimal to mild cytologic atypia; limited reticulin loss; relatively thin cell plates |
| G2 | Moderately differentiated | Thick cell plates; mild to moderate nuclear atypia; more prominent loss of reticulin |
| G3 | Poorly differentiated | Marked nuclear atypia and/or high mitotic activity; hepatocellular nature may not be clearly evident on morphology |
| G4 | Undifferentiated | No obvious hepatocellular or other differentiation on morphology or IHC; rarely used — more appropriately categorized as undifferentiated carcinoma |
Alternative grading systems
Edmondson and Steiner — based on nuclear features.
WHO 2010 scheme — based on differentiation.
The source excerpt used to build this tool named both systems and identified the general basis of each, but did not include their full tier-by-tier criteria. This tool does not reproduce or approximate those criteria — consult the primary sources directly if using either system.
The protocol does not require a specific system. It explicitly states this protocol does not preclude the use of other grading systems — but whichever system is used should be specified in the report.
Prognostic significance
Histologic grade has been shown to relate to tumor size, tumor presentation, and metastatic rate. Grade has been shown to be an independent predictor of outcome in many studies.
Sources
1. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954;7(3):462-503. (Original description of the nuclear-feature-based grading system; cited in the source protocol as reference 1.)
2. WHO Classification of Tumours Editorial Board — WHO 2010 digestive system tumours grading scheme (cited in the source protocol as reference 2).
3. AJCC Cancer Staging Manual, 8th edition — 4-tier hepatocellular carcinoma grading scheme (cited in the source protocol as reference 3).
4. Source protocol reference 4 — relationship of histologic grade to tumor size, presentation, and metastatic rate; grade as an independent predictor of outcome.
Full bibliographic detail for references 2 and 4 was not included in the supplied excerpt. Those specific citations are not fabricated here — consult the complete published protocol for exact references.