• Closeup of the hepatocellular carcinoma.

• Notice multiple foci of hemorrhage and necrosis which favors a malignant neoplasm.

•Hepatitis B (HBV) infection is strongly linked to the prevalence of hepatocellular carcinoma (HCC).

•Other correlations of hepatocellular carcinoma are the ingestion of aflatoxin.

•Very often, HCC arises on a background of cirrhosis.

•Repeated necrosis and regeneration of the liver, as happens in cirrhosis of any reason, is associated with the development of hepatocellular carcinoma.

•Primary carcinomas of the liver are extremely uncommon in Western Europe and represent around 1% of all reported cancers.

•However, in many parts of the Orient, particularly in areas where viral hepatitis is common, primary cancers of the liver can represent up to 40% of all reported malignancies.

•Males predominate over females at a ratio of 8:1.

•Clinically, poorly defined upper right quadrant pain associated with malaise, weight loss, decreased appetite and fatigue are often noticed.

•Associated symptoms due to the underlying cirrhosis may also be seen, including tendency to bruising and jaundice.

•Elevations of serum alpha-fetoprotin are found in a large number of cases.

•For information on prognosis and treatment, consult the NCI web site.
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•Grossly, hepatocellular carcinoma takes three forms, 1) a unifocal large mass; 2) multifocal with numerous nodules; or 3) a diffusely infiltrative form.

•In all cases, the hepatocellular lesion is clearly distinguishable from the rest of the liver parenchyma.

•Even unifocal large masses are often associated with small satellite nodules.

•The nodules of hepatocellular carcinoma can be bile stained if the liver cells retain sufficient differentiation to make bile.

•Microscopically, HCC includes a well differentiated form with cells that are recognizably hepatocyte in origin.

•The arrangement can either be that of a normal liver cell cords or a pseudo-glandular formation.

•As the tumor becomes more anaplastic, the liver cells can be bizarre and often sufficiently undifferentiated to become spindle.

•The tumor shows a distinct tendency to invade vascular channels and the presence of snake-like masses invading either the portal vein or the inferior vena cava.

• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 879

• Current literature from PubMed at National Library of Medicine