Pedunculated Hepatocellular Carcinoma: Clinicopathologic Study of 18 Surgically Resected Cases

Abstract

We present the clinical features and outcomes of 18 surgically treated pedunculated hepatocellular carcinomas (P-HCCs). Hepatocellular carcinoma is a notorious, hyperendemic disease in Taiwan. Pedunculated HCC, although not a novel finding, has been recognized and diagnosed early by various imaging modalities. However, the clinicopathologic picture has not been fully clarified, and the prognosis varies in each report. From 1986 to 1998 the clinical features of 18 surgically treated cases of P-HCC were reviewed, including demographics, laboratory data, operative findings, pathologic features, and follow-up results. Factors that may influence the outcomes were also analyzed. Clinical features and outcomes of 414 patients with nonpedunculated hepatocellular (HCC) were summarized for comparison. Of 432 surgical resected hepatocellular carcinomas, 18 (4.2%) were P-HCCs. Larger tumor size, more capsule formation, less vascular invasion, and wider resection margins were significantly prominent in the patients in P-HCC group compared with those in the NP-HCC group. Multivariate stepwise logistic regression analysis revealed that the P-HCC group had significantly larger tumors and wider resection margins. The 1-, 3-, and 5-year survival rates of P-HCC patients were 88.3%, 77.4%, and 45.6%, respectively. A significant difference in survival was found between the P-HCC and NP-HCC groups. P-HCC patients without vascular invasion might have a significantly better survival demonstrated by log-rank analysis stratified by capsular invasion, vascular invasion, resection, and tumor size. We present the clinical features and outcomes of 18 surgically treated pedunculated HCCs. Pedunculated HCCs might have a better survival than conventional HCCs after hepatic resection, especially if there is no vascular invasion.

Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: An angiographic demonstration

“…P-HCC is primarily treated by surgical resection, as a wider resection margin may be obtained, and patients have a higher percentage of capsule formation around the tumor, resulting in less vascular invasion than in conventional HCC (5). No symptoms present themselves in patients with early-stage P-HCC; however, once diagnosed, rapid tumor growth ensues, accompanied by intrahepatic metastasis and invasion of neighboring visceral organs (30).…”

“…P-HCC was first described by Roux in 1897 (2), and represents 0.24-3.00% of all cases of HCC in Japan (3,4). Additionally, to the best of our knowledge, <200 cases have been reported in previous studies (4)(5)(6).…”

“…The majority of P-HCC cases are treated surgically, with higher operability rates and better survival than conventional HCC, which may be due to its unique growth pattern, high rate of tumor capsule formation and lower vascular invasion (4)(5)(6). However, up to 39.4% of patients with P-HCC are unable to undergo surgical resection (7).…”

Histopathologie und Leberbiopsie des hepatozellulären Karzinoms

“…In den wenigen in der Literatur publizierten pedunkulierten HCCs besteht eine Verbindung zum Lebergewebe, ein sogenanntes Pedikel, jedoch werden auch Fälle beschrieben, in denen diese Verbindung zur Umgebungsleber nicht besteht. Diese Tumoren sollen eine bessere Prognose besitzen, obwohl größere Serien mit dokumentiertem Verlauf fehlen [3].…”

Pedunculated hepatocellular carcinoma and splenicmetastasis

“…To date, only a few cases have been reported [2][3][4] . The common sites of extrahepatic metastases in patients with hepatocellular carcinoma (HCC) are the lungs, regional lymph nodes, kidney, bone marrow and adrenals, which is via hematogenous metastasis.…”