肝脏不典型增生结节（HDN）在历史上曾有过多种名称，通常被认为是肝细胞癌的癌前病变，常见于肝硬化的背景上，根据细胞的异型程度可分为低度不典型增生结节和高度不典型增生结节，HDN可能会以一定的比例和速度以“结节内”和“结节外”的方式进展为HCC，HDN对于小肝癌的早期诊治意义重大。在病理诊断中，高度不典型增生结节（HGDN)和肝细胞肝癌（HCC）最有效的鉴别是间质浸润的有无。异型增生结节无特异性临床表现，与小肝细胞癌鉴别困难，术前诊断困难，主要依赖于影像学检查。B超、CT、MRI对HDN的检出率都不高，HDN在CT和MRI上的表现多样，MRI被认为是显示HDN相对最为敏感的影像学方法，一些新型造影剂对HDN的鉴别诊断可能有一定意义。某些免疫组化对HDN的病理诊断也可能有一定的意义。HDN不能按照肝癌随诊治疗，对于较大的HDN结节应该积极处理，在随访过程中结节性质发生改变时要积极处理。

Diagnosis and treatment of hepatic dysplastic nodule                 ZHENG Yong-chang, MAO Yi-lei. Department of Liver Surgery, Chinese Academy of Medical Sciences, Beijing Union Medical College Hospital , Beijing100730, China
Corresponding author: MAO Yi-lei, E-mail：yileimao@126.com
Abstract    Hepatic dysplastic nodule (HDN) is also known as other names historically，and generally considered as the premalignant lesion of hepatocellular carcinoma, and mostly happened in the background of hepatic cirrhosis. DNs are divided into low-grade dysplastic nodules and high-grade dysplastic nodules based on the dysplasi cell levels. HDN can progress into the HCC in intranodular and extranodular models with some certain speed, and is very important in the early diagnosis and treatment of the HCC. The most useful differential point of HGDN and HCC is existence of the interstitial diffusion. DN has no specific clinical manifestation and is difficult to make differential diagnosis with HCC before operation. The diagnosis is mainly based on the image examinations. The detection rate of the HDN in the CT，MRI and ultrasound is rare, and HDN has many radiological manifestations in the CT and MRI. MRI is considered as the most sensitive method, and also some new MRI contrast medium may play some roles in the differential diagnosis of HDN. Some ICH markers are also useful in the pathological diagnosis of HDN. The treatment of HDN is different from the HCC. The treatment strategy should be active for the larger HDN, and further treatment is necessary in the follow up when the characteristics changed in the HDN.