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01-02-2014 | Original Article

Hemodynamics and progression of a hypervascular focus in a borderline lesion of hepatocellular carcinoma: analysis by angiography-assisted CT and histopathology

Authors: Tamao Endo, Kazuto Kozaka, Satoshi Kobayashi, Junichiro Sanada, Wataru Koda, Tetsuya Minami, Azusa Kitao, Norihide Yoneda, Yasuni Nakanuma, Toshifumi Gabata, Osamu Matsui

Published in: Japanese Journal of Radiology | Issue 2/2014

Abstract

Purpose

To investigate the hemodynamics and progression of a hypervascular focus (HF) in a borderline lesion by dual-phase CT during hepatic arteriography (CTHA) and reveal the process of the transformation to hypervascular overt hepatocellular carcinoma (HCC).

Materials and methods

This study was performed with the approval of our institutional ethics committee, and informed consent for the retrospective usage of clinical materials was obtained from all the patients. The 121 nodules in 76 consecutive patients with liver cirrhosis and chronic hepatitis showing an HF in a borderline lesion on angiography-assisted CT were analyzed. Hemodynamic changes were observed in 24 patients who underwent repeated angiography-assisted CT. Histopathological analysis was conducted in eight nodules.

Results

HF was classifiable into type A (stain disappeared), B (stain prolonged), C (stain was washed out and corona-like drainage into the outer nodule was seen) and D (stain was washed out and corona-like drainage into the whole outer nodule was seen) on the late phase of CTHA and was seen to progress in this order on follow-up observation. Histopathologically, de-differentiated foci showed significantly higher expression of sinusoidal capillarization and unpaired arteries than background nodules and showed pseudocapsule, compressive and replacing growth at the border of the background nodule.

Conclusion

HF showed multi-step progression and transformation to hypervascular overt HCC.

Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.PubMedCrossRef

Wurmbach E, Chen YB, Khitrov G, Zhang W, Roayaie S, Schwartz M, et al. Genome-wide molecular profiles of HCV-induced dysplasia and hepatocellular carcinoma. Hepatology. [Research Support, NIH, Extramural Research Support, Non-US Gov’t]. 2007;45(4):938–47.

ICGHN, IWP. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology. 2009;49(2):658–64.

Nakamura K, Zen Y, Sato Y, Kozaka K, Matsui O, Harada K, et al. Vascular endothelial growth factor, its receptor Flk-1, and hypoxia inducible factor-1 alpha are involved in malignant transformation in dysplastic nodules of the liver. Hum Pathol. 2007;38(10):1532–46.PubMedCrossRef

Arakawa M, Kage M, Sugihara S, Nakashima T, Suenaga M, Okuda K. Emergence of malignant lesions within an adenomatous hyperplastic nodule in a cirrhotic liver. Observations in five cases. Gastroenterology. [Case Reports Research Support, Non-US Gov’t]. 1986;91(1):198–208.

Matsui O, Kadoya M, Kameyama T, Yoshikawa J, Takashima T, Nakanuma Y, et al. Benign and malignant nodules in cirrhotic livers: distinction based on blood supply. Radiology. 1991;178(2):493–7.PubMed

Hayashi M, Matsui O, Ueda K, Kawamori Y, Kadoya M, Yoshikawa J, et al. Correlation between the blood supply and grade of malignancy of hepatocellular nodules associated with liver cirrhosis: evaluation by CT during intraarterial injection of contrast medium. AJR. 1999;172(4):969–76.PubMedCrossRef

Hayashi M, Matsui O, Ueda K, Kawamori Y, Gabata T, Kadoya M. Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material. Radiology. 2002;225(1):143–9.PubMedCrossRef

Kitao A, Zen Y, Matsui O, Gabata T, Nakanuma Y. Hepatocarcinogenesis: multistep changes of drainage vessels at CT during arterial portography and hepatic arteriography–radiologic-pathologic correlation. Radiology. 2009;252(2):605–14.PubMedCrossRef

10.

Ueda K, Matsui O, Kawamori Y, Nakanuma Y, Kadoya M, Yoshikawa J, et al. Hypervascular hepatocellular carcinoma: evaluation of hemodynamics with dynamic CT during hepatic arteriography. Radiology. 1998;206(1):161–6.PubMed

11.

Murakami T, Takamura M, Kim T, Hori M, Federle MP, Onishi H, et al. Double phase CT during hepatic arteriography for diagnosis of hepatocellular carcinoma. Eur J Radiol. 2005;54(2):246–52.PubMedCrossRef

12.

Inoue E, Fujita M, Hosomi N, Sawai Y, Hashimoto T, Kuroda C, et al. Double phase CT arteriography of the whole liver in the evaluation of hepatic tumors. J Comput Assist Tomogr. 1998;22(1):64–8.PubMedCrossRef

13.

Shinmura R, Matsui O, Kadoya M, Kobayashi S, Terayama N, Sanada J, et al. Detection of hypervascular malignant foci in borderline lesions of hepatocellular carcinoma: comparison of dynamic multi-detector row CT, dynamic MR imaging and superparamagnetic iron oxide-enhanced MR imaging. Eur Radiol. 2008;18(9):1918–24.PubMedCrossRef

14.

Pugacheva O, Matsui O, Kozaka K, Minami T, Ryu Y, Koda W, et al. Detection of small hypervascular hepatocellular carcinomas by EASL criteria: Comparison with double-phase CT during hepatic arteriography. Eur J Radiol. 2011;80(3):e201–6.PubMedCrossRef

15.

Miyayama S, Matsui O, Yamashiro M, Ryu Y, Takata H, Takeda T, et al. Iodized oil accumulation in the hypovascular tumor portion of early-stage hepatocellular carcinoma after ultraselective transcatheter arterial chemoembolization. Hepatol Int. 2007;1(4):451–9.PubMedCrossRef

Title: Hemodynamics and progression of a hypervascular focus in a borderline lesion of hepatocellular carcinoma: analysis by angiography-assisted CT and histopathology
Authors: Tamao Endo
Kazuto Kozaka
Satoshi Kobayashi
Junichiro Sanada
Wataru Koda
Tetsuya Minami
Azusa Kitao
Norihide Yoneda
Yasuni Nakanuma
Toshifumi Gabata
Osamu Matsui
Publication date: 01-02-2014
Publisher: Springer Japan
Published in: Japanese Journal of Radiology / Issue 2/2014
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI: https://doi.org/10.1007/s11604-013-0268-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hemodynamics and progression of a hypervascular focus in a borderline lesion of hepatocellular carcinoma: analysis by angiography-assisted CT and histopathology

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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