Implications of hyperechoic lesions in small hepatocellular carcinoma

Abstract

Of 34 solitary small hepatocellular carcinomas (HCC) 2 cm in diameter or less, 13 with hyperechoic lesions were observed serially by sonography, and 11 of these were examined histologically. Serial examination showed that hypoechoic areas appeared at the periphery of or within, the hyperechoic tumor, and that these areas expanded more with tumor growth than the hyperechoic areas as if compressing or displacing the existing hyperechoic areas. Histologically, the hyperechoic lesions were composed mostly of well-differentiated cancer cells containing fat droplets, whereas the hypoechoic lesions were composed of cancer cells without fat droplets. In the two tumors that were formed almost completely of cancer cells showing fatty metamorphosis, cancer cells without fat droplets proliferated mainly in the periphery of the tumor. These findings suggest that, in hyperechoic HCC, cancer cells with fat droplets appear in the early stage of HCC, and probably change into concer cells without fat droplets by the time that a certain tumor size is reached, with gradual displacement by the latter type of cell during tumor growth.

Poor sensitivity of sonography in detection of hepatocellular carcinoma in advanced liver cirrhosis: accuracy of pretransplantation sonography in 118 patients

“…Usually, the liver is shrunken and small, and therefore sonic window is usually limited. Furthermore, there may be a large amount of ascites and the sonic window is further limited; therefore, it is difficult to detect small hepatocellular carcinomas in the cirrhotic parenchyma when cirrhosis is advanced and the liver is shrunken [11,12,13].…”

Liver X receptor mediates hepatitis B virus X protein–induced lipogenesis in hepatitis B virus–associated hepatocellular carcinoma #

“…3 Small HCC lesions at an early stage are often hyperechoic and are composed of well-differentiated cancer cells rich in triglyceride droplets. 4,5 Chronic infection with HBV and hepatitis C virus (HCV), two major causes of chronic liver disease, is frequently associated with hepatic steatosis. The frequency of steatosis in HCV infection ranges from 31% to 72%, whereas this risk in HBV infection varies from 27% to 51%.…”

Non-Asian hepatocellular carcinoma: correlation between histologic features and echogenicity.

“…In cases of Asian HCC, lesion hyperechogenicity has been attributed to the presence of one or more of five histologic features (i.e., nonliquefied necrosis, sinusoidal dilatation, fatty metamorphosis, hemorrhage, and fibrosis). 6,7,11 Our study of patients with HCC referred to a single institution in the United States does not reveal a statistically significant relationship between these five histologic features and the likelihood of hyperechogenicity. Since it is known that Asian and non-Asian forms of HCC differ substan-tially, 1,2 a discrepancy between these two populations with regard to sonographic-pathologic correlation is not surprising.…”