BACKGROUND Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resection or percutaneous ethanol injection (PEI). In this study, certain clinical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients with single HCC < 5 cm treated by PEI. METHODS After PEI treatment of HCC, the patients were followed for a mean period of 33 ± 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child‐Pugh score, hepatitis B virus surface antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha‐fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the posttreatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated. RESULTS The cumulative 4‐year intrahepatic recurrence rate of HCC was 62%. The log rank test indicated that, among pretreatment parameters, time from cirrhosis diagnosis >6 years (P = 0.05) and AFP level before PEI of >25 ng/mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P < 0.002). With regard to posttreatment parameters, an AFP level 1 month after PEI of >13 ng/mL was shown to be significantly related to tumor recurrence by the log rank test (P < 0.0001). CONCLUSIONS Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow‐up program. Cancer 1997; 79:1501‐8. © 1997 American Cancer Society.

The authors describe a case of subcutaneous neoplastic seeding in the abdominal wall in a 67-year-old man with posthepatitic liver cirrhosis complicated by a single nodule of well-differentiated hepatocellular carcinoma. He was treated with percutaneous ethanol injection (PEI) performed under ultrasound guidance. The neoplastic seeding developed along the needle track used to carry out fine-needle biopsy and PEI and was diagnosed 6 months after the beginning of treatment.

Gastric wall thickness (body-antrum) was blind measured prospectively by real-time ultrasound in 58 patients (30 with gastric cancer and 28 healthy) who had previously undergone endoscopy. Gastric wall thickness on the average measured 15.933 +/- 4.471 mm in the neoplastic patients and 5.107 +/- 1.100 mm in the normal subjects. Seven millimeters was the highest value found in the normal subjects (4 cases) and the minimum value found in the neoplastic patients (1 case). Knowing the normal gastric wall thickness value on a standard ultrasound examination of the upper abdomen is useful, as ultrasound is often performed as a screening or first-step procedure, in order to address the patients with higher values toward more specific techniques.

In the period 1985-1988, 62 focal liver lesions in 58 cirrhotic patients were studied by ultrasonography; 12 of these focal lesions were documented to be regenerating lesions by echo-guided fine-needle biopsy. During an average follow-up period of 10.2 months (range 3-22 months), hepatocellular carcinoma was subsequently found in 10 of the cases of regenerating nodules, whereas the initial diagnosis of regenerating nodule was confirmed in the remaining two cases. Based upon this finding, it is suggested that every focal mass visualized by ultrasonography in a cirrhotic liver should either be considered to be a neoplastic lesion or at least a preneoplastic lesion if the possibility of either a metastatic or benign lesion (eg, hemangiomas, focal fatty liver change areas) can be excluded. Therefore either fine-needle aspiration or biopsy of all ultrasonographically revealed mass lesions within a cirrhotic liver is advised, such that early appropriate treatment for hepatocellular carcinoma can be instituted.