title: Diffuse infiltrative hepatocellular carcinomas in a hepatitis B-endemic area: diagnostic and therapeutic impediments.
abstract: OBJECTIVE
  Clinical features of diffuse infiltrative hepatocellular carcinoma (D-HCC) are distinct from those of mass-forming HCCs, and also dependent on etiologic viruses. Moreover, despite a regular HCC-surveillance in those with chronic liver diseases, patients sometimes present with advanced D-HCCs. Thus, in the present study, we were to assess the risk factors, mode of diagnosis and prognosis of D-HCCs in a hepatitis B virus-endemic area.
  
  
  METHODS
  From January to June 2003, 35 patients who had been newly diagnosed as having D-HCC were enrolled. Their clinical characteristics were compared with those with other types of HCCs, who had been enrolled during the same period. Survival rates were analyzed using Kaplan-Meier method and Cox proportional hazard model.
  
  
  RESULTS
  D-HCC patients were younger and more commonly positive for HBsAg than those with other types of HCCs. During a regular follow-up, these tumors were not readily detectable in ultrasonography. Transarterial chemoembolization was beneficial in patients with good liver function as compared to supportive care, while this was not evident in those with poor hepatic reserve.
  
  
  CONCLUSIONS
  D-HCCs are not readily diagnosed using ultrasonography. These tumors are mostly resistant to treatment, while transarterial chemoembolization might be applied in patients with good liver function.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sun-Jung
authors.initials: SJ
authors.lastname: Myung
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Kang Mo
authors.initials: KM
authors.lastname: Kim
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Ji-Won
authors.initials: JW
authors.lastname: Yu
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Chung
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy* / Q000821:virology; D019353:Endemic Diseases; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors