title: Hepatocellular carcinoma: incidental finding in cirrhotic explanted livers.
abstract: BACKGROUND
  Cirrhosis predisposes to the development of hepatocellular carcinoma (HCC), demanding that these patients undergo follow-up with imaging methods for the early detection of neoplastic nodules. Morphologic study of the explanted livers allows identification of lesions not detected pre-operatively.
  
  
  OBJECTIVE
  To assess the frequency and to characterize the HCC found incidentally at pathological evaluation of explanted cirrhotic livers.
  
  
  METHODS
  Thirty patients had HCC diagnosed in explanted cirrhotic livers. The livers were sectioned at intervals of 0.5 cm. Each detached nodule was selected for microscopic study according to size, color and/or consistency. Retrospective analysis of the clinical records was performed comparing available data from various imaging methods.
  
  
  RESULTS
  In 11 patients, 16 HCC had previously been identified in the explants by one or more imaging methods. In the other 19 explanted livers (63.3%), HCC was incidentally found. All HCC identified in 9 patients and some of them in 10 patients were incidentally found, varying from microscopic focuses to 2 cm diameter lesions. They varied from only one (5 cases) to multiple nodules (7 cases).
  
  
  CONCLUSIONS
  Imaging methods may underestimate the number of HCC in cirrhotic livers. Histological study is an essential tool that can early detect tumor nodules not previously detected by imaging methods. In our study, although small, multicentric HCC were identified, illustrating the multifocal nature of the hepatic carcinogenesis. Future studies must correlate these findings with patient outcomes.
  
  
  CONCLUSIONS
  Characterization of explanted cirrhotic livers for HCC is important for previously known and incidentally found lesions.
authors.affiliation: Department of Pathology, Federal University of Rio de Janeiro, Brazil. caroli_bottino@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Caroli-Bottino
authors.forename: C M
authors.initials: CM
authors.lastname: Nascimento
authors.forename: S
authors.initials: S
authors.lastname: Basto
authors.forename: J
authors.initials: J
authors.lastname: Ribeiro
authors.forename: V
authors.initials: V
authors.lastname: Silveira
authors.forename: A M S
authors.initials: AM
authors.lastname: Carvalho
authors.forename: P N
authors.initials: PN
authors.lastname: Castro
authors.forename: C A
authors.initials: CA
authors.lastname: Villela-Nogueiro
authors.forename: V L
authors.initials: VL
authors.lastname: Pannain
mesh_terms: D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology*; D006526:Hepatitis C / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D008104:Liver Cirrhosis, Alcoholic / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology*