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Liver and intrahepatic bile ducts - tumor

Hepatocellular carcinoma

Small hepatocellular carcinoma


Reviewers: Deepali Jain, M.D. (see Reviewers page)
Revised: 9 January 2013, last major update February 2012
Copyright: (c) 2004-2013, PathologyOutlines.com, Inc.

General
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● Defined as tumor less than 2 cm
● Detected by screening of patients with chronic liver disease

Clinical features
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● May have normal serum AFP
● Good prognosis
● Two types: (a) gross and histologic features similar to classic HCC (small HCC of distinct nodular type), (b) "early HCC", well-differentiated with indistinct margins (vaguely nodular type)
● Early HCC is distinguished from dysplastic nodule by stromal invasion, absence of ductular reaction, and panel of HSP70, Glypican 3 and Glutamine Synthetase (72% sensitive, 100% specific for early HCC if at least 2 markers are positive, Hepatology 2007;45:725); inclusion of clathrin heavy chain (CHC) improves diagnostic accuracy (Gut 2012;61:10)
● Radiologically, early HCC is hypovascular, isovascular or very rarely hypervascular

Gross description
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● Vaguely nodular type: either not identifiable or nodules that bulge from cut surface
● Gray, white, green or yellow; no necrosis; may be within borderline nodule (nodule within nodule)
● Usually distinct fibrous capsule or fibrous septa; may have indistinct borders

Gross images
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Early HCC

Micro description
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● Usually well-differentiated morphology with irregular thin trabeculae 2-3 cells thick
● Nuclear density is 2x normal, mild but definite nuclear atypia (hyperchromasia, irregular nuclear borders)
● Unpaired arteries present; no substantial paucity of reticulin fibers
● Enlarging nodules have less differentiated foci centrally
● 40% have fatty or clear cell change, often with Mallory bodies
● May invade stroma or portal tract, but vascular invasion and intrahepatic metastases are rare

Micro images
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Early HCC

   
Associated with Hepatitis C

End of Liver and intrahepatic bile ducts - tumor > Hepatocellular carcinoma > Small hepatocellular carcinoma


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