HCC Part 6: Hepatocarcinogenesis: HCC - Progressed

HCC - Proposed classification by International consensus group on HCC & WHO

PROGRESSED HCC (DISTINCTLY NODULAR ):

Majority are moderately differentiated with distinct margins

         1. Ability to invade vessels & metastasize

         2. Moderately Differentiated < 2 cm

         2. Bigger  size (> 2 cm)

         3. Well marginated  - surrounded by tumor capsule & contain internal septations         

         4. Propensity to portal vein invasion

         5. Hypervascular

         6. Show intra-hepatic metastasis

         7. Predominantly unpaired arteries

Macrosocpic Subtypes: 

- Nodular: encapsulated

- Multinodular: Aggregation of multiple small nodular type

- Massive : Large tumor with irregular demarcation

- Mosaic Architecture: tumor nodules separated by fibrous septations, hemorrhage, necrosis or fatty metamorphosis. 

- Pedunculated / Protruded: Grows extrahepatically with or without a peduncle   

MULTIFOCAL (overlap of terminology):

- Tumor nodules separated by intervening non-neoplastic parenchyma. 

- Multicentric: synchronous development of multiple interdependent tumors

- Intrahepatic metastasis" 

- Cirrhotomimetic / infiltrative : Cirrhotic like HCC or confluent multinodular with a "macroscopic appearance of innumerable permeating tumor nodules that resemble cirrhosis". 

It can evade clinical and imaging. Usually poorly differentiated or undifferentiated

-Diffuse

Prepared by Dr. Sharad Maheshwari

31.07.2023

Updated: 

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907961/  

2. https://www.clinicalkey.in/service/content/pdf/watermarked/1-s2.0-S2352621117300244.pdf?locale=en_US&searchIndex=

3. https://pubs.rsna.org/doi/epdf/10.1148/radiol.14132361

4. https://pubmed.ncbi.nlm.nih.gov/25473149/

5. https://pubmed.ncbi.nlm.nih.gov/36010991/