Clinicopathological study of minimum-sized hepatocellular carcinoma: an approach to the definition of early hepatocellular carcinoma.
Clinicopathologic examination of 33 nodules from 23 cases of minimum-sized hepatocellular carcinoma (HCC), less than 15 mm in diameter, was carried out by imaging and clinical follow up. On ultrasound (US), 16 hypoechoic nodules (48%) and 15 hyperechoic nodules (45%) on angiography 7 tumour stains (21%) and on computerized tomography (CT) 3 low density nodules (9%) were detected. Of 27 nodules on lipiodol CT (LpCT), 7 lipiodol-deposited nodules (26%) were detected. Of 16 nodules on CO2US angiography (US-angiography), 7 hypervascular (44%), 5 hypovascular (31%) and 4 isovascular nodules (25%) were detected. Of 13 nodules on CT during arterial portography (CTAP), 7 perfusion defect nodules (54%) were detected. The nodules were graded according to the Edmondson & Steiner Classification. Three nodules were resected; grossly, two were not distinct and one was poorly demarcated. Histologically, they were highly differentiated with irregularly-thin trabecular-patterned HCC where portal triads were detected. Cancer cells invaded the non-cancerous liver cells by replacement, and the border between the cancerous and non-cancerous regions was unclear; the latter region manifested chronic hepatitis or liver cirrhosis without hyperplasia. Minimum-sized HCC is characteristically hypovascular in arterial and portal supply of blood, of multicentric origin and of a well-differentiated pattern. Because the three resected nodules did not damage the liver acinus structure, they were considered to be an early stage of HCC.
Kim
S R
SR
Department of Gastroenterology, Kobe Asahi Hospital, Japan.
Kang
K B
KB
Soh
C G
CG
Kim
J H
JH
Hayashi
Y
Y
Hanioka
K
K
Itoh
H
H
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D014463:Ultrasonography