Microscopic Incipient Hepatocellular Carcinoma Found Incidentally in A Routine Liver Biopsy Specimen

Abstract

A microscopic atypical focus suggestive of hepatocellular carcinoma is reported. The lesion, 0.3 mm in diameter, was found by chance in a liver biopsy specimen taken from a cirrhotic patient; it was characterized histologically by cytoplasmic basophilia, hypercellularity (high nucleus-to-cell ratio) and microacinar structures. The reticulin framework of the focus was relatively sparse compared with the surrounding noncancerous area. The focus had developed in a regenerative nodule apparently no different from other regenerative nodules of the cirrhosis and showed no accompanying preneoplastic lesion such as adenomatous hyperplasia. A thorough search for the primary lesion, including ultrasonographic imaging and superselective hepatic arteriography, demonstrated no mass lesion in the liver. Therefore, the lesion may have been an incipient de novo hepatocellular carcinoma, and this may be the first report of such a lesion discovered in a biopsy sample.

Computed tomography angiographic findings in hepatocellular carcinoma less than 2 cm detected during follow‐up in 29 patients

“…It has been established that very early HCC frequently develops within such adenomatous dysplastic nodules as a nodule‐in‐nodule 10–13 . HCC can arise in an ordinary cirrhotic nodule, but this is rare 19 . The blood supply slowly changes within such a nodule‐in‐nodule that turns into early HCC, and as it dedifferentiates it comes to be supplied by arteries (neovascularization) 14–16 .…”

“…[10][11][12][13] HCC can arise in an ordinary cirrhotic nodule, but this is rare. 19 The blood supply slowly changes within such a nodule-innodule that turns into early HCC, and as it dedifferen-tiates it comes to be supplied by arteries (neovascularization). [14][15][16] There is a period during which blood supply to the mass changes from portal to arterial, and such changes have been demonstrated by modern imaging.…”