title: Satellite lesions in patients with small hepatocellular carcinoma with reference to clinicopathologic features.
abstract: BACKGROUND
  It is not rare to find satellite lesions in patients with small hepatocellular carcinoma (HCC). The purpose of this study was to elucidate the factors associated with satellite lesions in these patients.
  
  
  METHODS
  We investigated the prevalence of satellite lesions, the relationship of clinicopathologic factors to satellite lesions, and the distance from the main tumor to the satellite lesion in 149 patients. Patients, who had a solitary HCC of 3.0 cm or less in diameter but no satellite lesions on preoperative imaging procedures, underwent potentially curative resection. The main tumors were macroscopically classified into four groups: early HCC, a vaguely nodular type showing preservation of the preexisting liver structure; single nodular type; single nodular type with extranodular growth; and confluent multinodular type.
  
  
  RESULTS
  Of 149 resected specimens, 28 (19%) showed satellite lesions. Of the clinicopathologic factors investigated, the macroscopic type and tumor differentiation were significantly associated with the prevalence of satellite lesions. Both the single nodular type with extranodular growth and the confluent multinodular type showed satellite lesions more frequently than the early HCC and the single nodular type. A significantly higher prevalence of satellite lesions was observed in poorly differentiated HCC than in well and moderately differentiated HCC. The satellite lesions were located 0.5 cm or less from the main tumor in 8 (33%) specimens, 0.6-1.0 cm in 12 (50%), and 1.1-2.0 cm in 4 (17%). No identifiable factors were significantly related to the distance from the main tumor to the satellite lesion. However, all satellite lesions located more than 1.0 cm from the main tumor coexisted with poorly differentiated HCC, which were the single nodular type with extranodular growth or the confluent multinodular type.
  
  
  CONCLUSIONS
  In the single nodular type with extranodular growth, confluent multinodular type, and poorly differentiated HCC, extensive treatment achieving a large safety margin and/or frequent posttreatment follow-up examinations may be needed because of the high prevalence of satellite lesions.
authors.affiliation: Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan. tokusaka@ncc.go.jp
authors.forename: Takuji
authors.initials: T
authors.lastname: Okusaka
authors.forename: Shuichi
authors.initials: S
authors.lastname: Okada
authors.forename: Hideki
authors.initials: H
authors.lastname: Ueno
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
authors.forename: Susumu
authors.initials: S
authors.lastname: Yamasaki
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Fukushima
authors.forename: Michiie
authors.initials: M
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged