Outcomes of small nodular lesions in heavy drinkers.
BACKGROUND
Increased detection of nodular lesions in patients not yet definitively diagnosed with hepatocellular carcinoma (HCC) has occurred with the use of advanced imaging techniques. In heavy drinkers, decrease in the size of nodular lesions during on-going observation, and negation of diagnoses of HCC after surgical resection have been reported, suggesting the need for caution in diagnosis in such cases.


METHODS
The subjects were eight heavy drinkers with small nodular lesions, 20 mm or less in diameter. All patients were male, with a mean age of 53 years. Five had single and three had multiple nodular lesions. Five of the eight patients were followed up for more than 4 years after an initial biopsy, while three patients were recent cases. Of the three recent cases, two were positive for antibody to hepatitis C virus (HCV) and two had hypervascular nodular lesion. Biopsies were performed percutaneously, under ultrasonography, for histological diagnosis of all cases, and the recent cases were also assessed using a variety of imaging techniques.


RESULTS
On initial biopsy, no atypism (NO) was found in two patients, and borderline lesions (Border) were present in six patients. Of the five cases followed up long-term, only one of the two with NO progressed to HCC, and the three with Border showed disappearance, decrease, and no change, respectively, during the follow-up period. Of the three recent cases, no changes in size or morphology as revealed by imaging were observed following biopsy.


CONCLUSIONS
In heavy drinkers, no fixed relationship was observed between initial biopsy finding and clinical course, suggesting that indication for biopsy requires reassessment, refinement, and discussion. Furthermore, tumor staining may occur in hyperplastic nodules, which are histologically similar to early HCC by needle biopsy, and care needs to be exercised for diagnosis in heavy drinkers.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki-shi, Kanagwa, Japan. michstmu@marianna.u.ac.jp
Michihiro
M
Suzuki
Shiro
S
Maeyama
Kouji
K
Nishikawa
Noriaki
N
Okuse
Kiyoe
K
Hashizume
Yukimitu
Y
Mamada
Yutaro
Y
Kobayashi
Chiaki
C
Okuse
Yasuhito
Y
Takahashi
Taturo
T
Osada
Takeshi
T
Hayashi
Hiroshi
H
Yotuyanagi
Hiroshi
H
Suzuki
Seiichiro
S
Ogata
Toshiyuki
T
Uchikoshi
Shiro
S
Iino
D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D003952:Diagnostic Imaging; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology; D008104:Liver Cirrhosis, Alcoholic / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*