Summary
Of 34 solitary small hepatocellular carcinomas (HCC) 2 cm in diameter or less, 13 with hyperechoic lesions were observed serially by sonography, and 11 of these were examined histologically. Serial examination showed that hypoechoic areas appeared at the periphery of or within, the hyperechoic tumor, and that these areas expanded more with tumor growth than the hyperechoic areas as if compressing or displacing the existing hyperechoic areas. Histologically, the hyperechoic lesions were composed mostly of well-differentiated cancer cells containing fat droplets, whereas the hypoechoic lesions were composed of cancer cells without fat droplets. In the two tumors that were formed almost completely of cancer cells showing fatty metamorphosis, cancer cells without fat droplets proliferated mainly in the periphery of the tumor. These findings suggest that, in hyperechoic HCC, cancer cells with fat droplets apear in the early stage of HCC, and probably change into concer cells without fat droplets by the time that a certain tumor size is reached, with gradual displacement by the latter type of cell during tumor growth.
Similar content being viewed by others
References
Green B, Bree RL, Goldstein HM, et al: Gray scale ultrasound evaluation of hepatic neoplasms: Patterns and correlations. Radiology 1977;124:203–208
Hillman BJ, Smith EH, Gammelgaard J, et al: Ultrasonographic-pathologic correlation of malignant hepatic masses. Gastrointest Radiol 1979;4:361–365
Kamin PD, Bernardino ME, Green B: Ultrasound manifestations of hepatocellular carcinoma. Radiology 1979;131:459–461
Makuuchi M, Hasegawa H, Yamazaki S, et al: Ultrasonic characteristics of the small hepatocellular carcinoma. In: Lerski RA, Morley P, eds. Ultrasound. Pergamon Press, Oxford. 1982;489–491
Sheu JC, Sung JL, Chen DS, et al: Ultrasonography of small hepatic tumors using high-resolution linear-array real-time instruments. Radiology 1984;150:797–802
Majima Y, Fujimoto T, Iwai I, et al:Histological diagnosis of hepatocellular carcinoma by a new technique of ultrasoundguided fine needle biopsy. Acta Hepat Jap 1988;29:628–636 (in Jpn)
Osada Y: Clinicopathological studies of ultrasonogram in small hepatocellular carcinoma. Jpn J Gastroenterol 1981;78: 685–692 (in Jpn)
Shinagawa T, Ohto M, Kimura K, et al: Real-time ultrasonographic diagnosis of hepatocellular carcinoma: Correlation of echograms and histopathological findings. Jpn J Gastroenterol 1981;78:2402–2411 (in Jpn)
Tanaka S, Kitamura T, Imaoka S, et a: hepatocellular carcinoma: Sonographic and histologic correlation. AJR 1983;140: 701–707
Horiguchi Y, Taguchi H, Kitano T, et al: A case of hepatocellular carcinoma consisted with heterogenous nodules with and without production of AFP. Acta Hepat Jap 1985;26:357–362 (in Jpn)
Liver Cancer Study Group of Japan: the general rules for the clinical and pathological study of primary liver cancer. 2nd ed, Kanehara, Tokyo. 1987;18
Yamada R, Sato M, Kawabata M, et a: Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983;148:397–401
Shinagawa T, Ukaji H, Lino Y, et al: Intratumoral injection of absolute ethanol under ultrasound imaging for treatment of small hepatocellular carcinoma: Attempts in three cases. Acta Hepat Jap 1985;26:99–105 (in Jpn)
Brawer MK, Austin GE, Lewin KJ: Focal fatty change of the liver, a hitherto poorly recognized entity. Gastroenterology 1980;78:247–252
Edmondson HA, Steiner PE: Primary carcinoma of the liver: A study of 100 cases among 48,9000 necropsies. Cancer 1954;7:462–503
Miyaji T: Association of hepatocellular carcinoma with cirrhosis among autopsy cases in Japan during 14 years from 1958 to 1971. Gann Monogr Cancer Res 1976;18:129–149
Kurioka N, Oka H, Asai H: Significance and some problems, of the screening of hepatoma by ultrasound. Jpn J Med Ultrasonics 1988;15:67–68 (in Jpn)
Bree RL, Schwab RE, Neiman HL: Solitary echogenic spot in the liver: Is it diagnostic of a hemangioma? AJR 140;1983: 41–45
Nakanuma Y, Sugiura H, Ohta G: Cytoplasmic expressions seen in hepatocellular carcinoma. Acta Hepat Jap 1981;22:266–273 (in Jpn)
Kondo F, Hirooka N, Wada K, et al: Morphological clues for the diagnosis of small hepatocellular carcinoma. Virchows Arch A 1987;411:15–21
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kanno, T., Kurioka, N., Kim, S. et al. Implications of hyperechoic lesions in small hepatocellular carcinoma. Gastroenterol Jpn 24, 528–534 (1989). https://doi.org/10.1007/BF02773880
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02773880