Skip to main content
SpringerLink
Log in

Hepatocellular carcinoma in non-cirrhotic versus cirrhotic liver: a clinico-radiological comparative analysis

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 06 August 2020

A Letter to the Editor to this article was published on 03 August 2020

Abstract

Aim

To compare clinico-radiological pattern of non-cirrhotic versus cirrhotic HCC and correlate them with histopathological tumor grade.

Materials and methods

This prospective study was carried out on 94 patients enrolled following ultrasound diagnosis of a liver mass measuring > 3 cm. Multiphasic MDCT was performed on all treatment-naïve cases and 56 cases with imaging pattern consistent with unifocal HCC were selected. Background liver parenchyma was assessed on ultrasound for cirrhosis and NAFLD. Cases were categorized into cirrhotic liver (CL) and non-cirrhotic liver (NCL) groups with 26 and 30 cases, respectively, and guided biopsy of each liver mass was performed. AFP levels were compared in both groups. Serum markers for hepatitis B and C were assessed. Masses in both groups were compared for morphology, attenuation on each phase and washout time. Presence of capsule, corona enhancement, satellite nodules and portal vein invasion was noted.

Results

AFP level was higher in CL group. HBV serum marker was raised in both groups. Most HCCs in NCL were moderately differentiated (histopathology), larger, had well-defined margins, showed mosaic pattern of enhancement, complete capsule and delayed phase washout. Majority in CL group were poorly differentiated, smaller, had ill-defined margins, showed heterogeneous enhancement, absent capsule and portal venous phase washout. Time of washout correlated with histopathological differentiation of masses, with earlier washout indicating poorer differentiation.

Conclusion

HCCs in NCL have different clinico-radiological characteristics than HCCs in CL. Time of contrast washout correlates with histopathological grade of HCC. Non-cirrhotic NAFLD may require formulation of new screening guidelines for HCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nzeako UC, Goodman ZD, Ishak KG. Hepatocellular carcinoma in cirrhotic and noncirrhotic livers: A clinico-histopathologic study of 804 North American patients. Am J Clin Pathol 1996;105:65-75.

    Article  CAS  Google Scholar 

  2. Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127:S35-S50.

    Article  Google Scholar 

  3. Song DS, Bae SH. Changes of guidelines diagnosing hepatocellular carcinoma during the last ten-year period. Clin Mol Hepatol 2012;18:258-267.

    Article  Google Scholar 

  4. Schütte K, Schulz C, Poranzke J, Antweiler K, Bornschein J, Bretschneider T, et al. Characterization and prognosis of patients with hepatocellular carcinoma (HCC) in the non-cirrhotic liver. BMC Gastroenterol 2014;14:117.

    Article  Google Scholar 

  5. Sharma S. Non-invasive diagnosis of advanced fibrosis and cirrhosis. World J Gastroenterol 2014;20:16820-16830.

    Article  Google Scholar 

  6. Kumar A, Singh A, Panda P, Nischal N, Soneja M. Non-alcoholic fatty liver disease diagnosis, grading and staging; a simplified tool for clinicians. Journal of Advances in Medicine 2017;6:15. https://doi.org/10.5958/2319-4324.2017.00003.7

    Article  Google Scholar 

  7. Martins-Filho SN, Paiva C, Azevedo RS, Alves VAF. Histological grading of hepatocellular carcinoma – A systematic review of literature. Front Med 2017;4:193.

    Article  Google Scholar 

  8. Matsui O. Imaging of multistep human hepatocarcinogenesis by CT during intra-arterial contrast injection. Intervirology 2004;47:271-6.

    Article  Google Scholar 

  9. Gaddikeri S, McNeeley MF, Wang CL, Bhargava P, Dighe MK, Yeh MMC, et al. Hepatocellular carcinoma in the noncirrhotic liver. Am J Roentgenol 2014;203:W34-W47.

    Article  Google Scholar 

  10. Brancatelli G, Federle MP, Grazioli L, Carr BI. Hepatocellular carcinoma in noncirrhotic liver: CT, clinical and pathologic findings in 39 U.S. residents. Radiology 2002;222:89–94.

  11. Desai A, Sandhu S, Lai JP, Sandhu DS. Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review. World J Hepatol 2019;11:1-18.

    Article  Google Scholar 

  12. Yoon SH, Lee JM, So YH, Hong SH, Kim SJ, Han JK, et al. Multiphasic MDCT enhancement pattern of hepatocellular carcinoma smaller than 3 cm in diameter: Tumor size and cellular differentiation. Am J Roentgenol 2009;193(6).W482-W489. https://doi.org/10.2214/ajr.08.1818

  13. Asayama Y, Yoshimitsu K, Nishihara Y, Irie H, Aishima S, Taketomi A, et al. Arterial blood supply of hepatocellular carcinoma and histologic grading: Radiologic-Pathologic correlation. Am J Roentgenol 2008;190:W28-W34.

    Article  Google Scholar 

  14. Sparchez Z, Mocan T. Contemporary role of liver biopsy in hepatocellular carcinoma. World J Hepatol 2018;10:452-461.

    Article  Google Scholar 

  15. Madrazo BL. Diagnosis of nonalcoholic steatohepatitis without liver biopsy. Gastroenterol Hepatol (N Y) 2017;13:378-380.

    Google Scholar 

  16. Shim CW, Park JW, Kim SH, Kim JS, Kim BH, Kim SH, et al. Noncirrhotic hepatocellular carcinoma: etiology and occult hepatitis B virus infection in a hepatitis B virus-endemic area. Therap Adv Gastroenterol 2017;10:529-536.

    Article  Google Scholar 

  17. Di Bisceglie AM. Hepatitis B and hepatocellular carcinoma. Hepatology 2009;49:S56-S60.

    Article  Google Scholar 

  18. Perumpail RB, Liu A, Wong RJ, Ahmed A, Harrison SA. Pathogenesis of hepatocarcinogenesis in non-cirrhotic nonalcoholic fatty liver disease: Potential mechanistic pathways. World J Hepatol. 2015;7(22):2384–2388.

    Article  Google Scholar 

  19. Paradis V, Zalinski S, Chelbi E, Guedj N, Degos F, Vilgrain V, et al. Hepatocellular carcinomas in patients with metabolic syndrome often develop without significant liver fibrosis: A pathological analysis. Hepatology 2008;49:851-9.

    Article  Google Scholar 

  20. Leung C, Yeoh SW, Patrick D, Ket S, Marion K, Paul G, et al. Characteristics of hepatocellular carcinoma in cirrhotic and non-cirrhotic non-alcoholic fatty liver disease. World J Gastroenterol 2015;21:1189-1196.

    Article  Google Scholar 

  21. Trevisani F, D'Intino PE, Caraceni P, Pizzo M, Stefanini GF, Mazziotti A, et al. Etiologic factors and clinical presentation of hepatocellular carcinoma. Differences between cirrhotic and noncirrhotic Italian patient. Cancer 1995;75:2220–2232.

  22. Burnett NP, Dunki-Jacobs EM, Callender GG, Anderson RJ, Scoggins CR, McMasters KM, et al. Evaluation of alpha-fetoprotein staging system for hepatocellular carcinoma in noncirrhotic patients. Am Surg 2013;79:716-22.

    PubMed  Google Scholar 

  23. Bai DS, Zhang C, Chen P, Jin SJ, Jiang GQ. The prognostic correlation of AFP level at diagnosis with pathological grade, progression, and survival of patients with hepatocellular carcinoma. Scientific Reports 2017;7(1):12870.

    Article  Google Scholar 

  24. Iannaccone R, Laghi A, Catalano C, Rossi P, Mangiapane F, Murakami T, et al. Hepatocellular carcinoma: Role of unenhanced and delayed phase multi-detector row helical CT in patients with cirrhosis. Radiology 2005;234:460-7.

    Article  Google Scholar 

  25. Nakachi K, Tamai H, Mori Y, Shingaki N, Moribata K, Deguchi H, et al. Prediction of poorly differentiated hepatocellular carcinoma. Cancer Imaging 2014;14:7. https://doi.org/10.1186/1470-7330-14-7

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ishizaki M, Asida K, Higashi T, Nakatsukasa H, Kaneyoshi T, Fujiwara K, et al. The formation of capsule and septum in human hepatocellular carcinoma. Virchows Arch 2001;438:574-80.

    Article  CAS  Google Scholar 

  27. Karahan OI, Yikilmaz A, Isin S, Orhan S. Characterization of hepatocellular carcinomas with triphasic CT and correlation with histopathologic findings. Acta Radiologica 2003;44:566-571.

    Article  CAS  Google Scholar 

  28. Nishie A, Yoshimitsu K, Okamoto D, Tajima T, Asayama Y, Ishigami K, et al. CT prediction of histological grade of hypervascular hepatocellular carcinoma: utility of the portal phase. Jpn J Radiol 2013;31:89-98.

    Article  Google Scholar 

  29. Furlan A, Marin D, Vanzulli A, Patera GP, Ronzoni A, Midiri M, et al. Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout. Br J Radiol 2011;84:403-412.

    Article  CAS  Google Scholar 

  30. Liu YI, Shin LK, Jeffrey RB, Kamaya A. Quantitatively defining washout in hepatocellular carcinoma. Am J Roentgenol 2013;200:84-89.

    Article  Google Scholar 

  31. Lim JH, Choi D, Park CK, Lee WJ, Lim HK. Encapsulated hepatocellular carcinoma: CT-pathologic correlations. Eur Radiol 2006;16:2326-2333.

    Article  Google Scholar 

  32. Lafitte M, Laurent V, Soyer P, Ayav A, Balaj C, Petit I, et al. MDCT features of hepatocellular carcinoma (HCC) in non-cirrhotic liver. Diagn Interv Imaging 2016;97:355-360.

    Article  CAS  Google Scholar 

  33. Castán A, Navarro Y, Sarría L, Larrosa R, Serradilla M, Serrablo A. Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients. Hepatoma Res 2017;3:1-17.

    Article  Google Scholar 

  34. Thompson SM, Garg I, Ehman EC, Sheedy SP, Bookwalter CA, Carter RE, et al. Non-alcoholic fatty liver disease-associated hepatocellular carcinoma: effect of hepatic steatosis on major hepatocellular carcinoma features at MRI. Br J Radiol 2018;91:20180345. https://doi.org/10.1259/bjr.20180345 .

    Article  PubMed  PubMed Central  Google Scholar 

  35. Li M, Xin Y, Fu S, Liu Z, Li Y, Hu B, et al. Corona enhancement and mosaic architecture for prognosis and selection between of liver resection versus transcatheter arterial chemoembolization in single hepatocellular carcinomas >5 cm without extrahepatic metastases. Medicine 2016;95:e2458. https://doi.org/10.1097/MD.0000000000002458

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Unal E, Idilman IS, Akata D, Ozmen MN, Karcaaltincaba M. Microvascular invasion in hepatocellular carcinoma. Diagn Interv Radiol 2016;22:125-132.

    Article  Google Scholar 

Download references

Acknowledgements

We owe special thanks to the Department of Pathology, Vardhaman Mahavir Medical College and Safdarjung Hospital for their invaluable aid in the histopathological confirmation and assessment of the biopsy samples from our study.

Funding

Nil.

Author information

Authors and Affiliations

  1. Department of Radiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

    Rupie Jamwal, Venkatram Krishnan, Dinesh Singh Kushwaha & Rajat Khurana

Authors
  1. Rupie Jamwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Venkatram Krishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dinesh Singh Kushwaha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajat Khurana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Venkatram Krishnan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in our study were in accordance with the ethical standards of the institutional research committee (Institutional ethics committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jamwal, R., Krishnan, V., Kushwaha, D.S. et al. Hepatocellular carcinoma in non-cirrhotic versus cirrhotic liver: a clinico-radiological comparative analysis. Abdom Radiol 45, 2378–2387 (2020). https://doi.org/10.1007/s00261-020-02561-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02561-z

Keywords

Search

Navigation