Fact-sheet: Hepatocellular carcinoma


Updated on 09/01/2021 at 11:39 AM

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Definition

Primary malignant liver tumor derived from hepatocytes, the leading etiologies being cirrhosis (alcoholic, hemochromatosis, cardiac, biliary atresia), and chronic viral hepatitis (HBV, HCV)

Other causes: Aflatoxin, Siderosis, Thorotrastosis, Oral contraceptives and anabolic steroids, Alpha-1 antitrypsin deficiency, Galactosemia, von Gierke disease, Wilson disease, Tyrosinosis

Laboratory findings

Elevated alpha-fetoprotein in 75-90% of cases.
Abnormal liver function tests.
Paraneoplastic syndrome

Ultrasound

Variable echogenicity: Hyperechoic (13%), Hypoechoic (26%), Heterogeneous (61%).
Hypervascularity on color Doppler.
Calcifications (rare)

On contrast-enhanced ultrasound: Hypervascularity at the early phase followed by washout relative to the rest of the liver, with hypoechogenicity at the portal or delayed phase. Allows confirmation of portal vein thrombosis

CT

Hypodense mass, rarely iso- or hyperdense in a steatotic liver.
Marked enhancement at the arterial phase (80%).
Hypodense at the portal phase with heterogeneous areas.
Satellite nodules.
Portal vein thrombosis.
Metastases: lung, adrenal glands, lymph nodes, bone.
Possible mosaic pattern caused by multiple nodules and cirrhosis.
Possible infiltrative HCC.
Possible encapsulated HCC

MRI

T1: hyposignal (50%) or iso- to hypersignal.
The capsule is hyposignal on T1, with peripheral hypersignal on T2.
Moderate T2 hypersignal.
Possible central scar, areas of fibrosis, necrosis, calcifications.
Hypervascularity at the arterial phase, followed by washout.
Look for satellite nodules, portal vein thrombosis, lymphadenopathy, metastases

Vascular intervention

Hypervascularity of HCC at the arterial phase.
Procedure indicated for performing chemoembolization

Classification

Modified Barcelona classification: nodule on a cirrhotic liver:
typical vascular profile = arterial phase enhancement, washout at the portal phase or later.
< 1 cm = follow-up at 3 months.
1-2 cm: typical vascular profile on 2 different contrast-enhanced imaging modalities (CT and MRI) = HCC.
> 2 cm: typical vascular profile on one contrast-enhanced imaging modality (CT or MRI) = HCC.
In other cases: biopsy most often

Differential diagnosis

Cholangiocarcinoma.
Focal nodular hyperplasia.
Adenoma.
Dysplastic nodule.
Hemangioma.
Hepatoblastoma in children