Pathological Basis of Imaging in Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most prevalent form of liver cancer with major risk factors being chronic liver disease (CLD) including chronic liver inflammation, steatohepatitis and certain viral infections (Hepatitis B and C). Due to the poor prognosis, early detection is key for effective management. Imaging of HCC has developed over the years with specificity as high as 95%. The Liver Imaging Reporting and Data System (LI-RADS) provides a standardized reporting format that can be followed by radiologists and clinicians alike. This article focuses on the pathological basis of imaging observations described in the LI-RADS lexicon. A clear understanding of the pathological basis of imaging will help the radiologist to be more confident to resolve unequivocal observations apart from achieving a high degree of specificity in the diagnosis of HCC.

Keywords

computed tomography - hepatocellular carcinoma - Liver Imaging Reporting and Data System - magnetic resonance imaging

Publication History

Article published online:
17 April 2023

• References

• 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
• 2 Trevisani F, Cantarini MC, Wands JR, Bernardi M. Recent advances in the natural history of hepatocellular carcinoma. Carcinogenesis 2008; 29 (07) 1299-1305
• 3 Sagnelli E, Macera M, Russo A, Coppola N, Sagnelli C. Epidemiological and etiological variations in hepatocellular carcinoma. Infection 2020; 48 (01) 7-17
• 4 McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology 2021; 73 (Suppl (Suppl. 01) 4-13
• 5 Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. Development, growth, and spread: key pathologic and imaging aspects. Radiology 2014; 272 (03) 635-654
• 6 Tarao K, Nozaki A, Ikeda T. et al. Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases-meta-analytic assessment. Cancer Med 2019; 8 (03) 1054-1065
• 7 Chernyak V, Fowler KJ, Kamaya A. et al. Liver Imaging Reporting and Data System (LI-RADS) version 2018: imaging of hepatocellular carcinoma in at-risk patients. Radiology 2018; 289 (03) 816-830
• 8 Katabathina VS, Khanna L, Surabhi VR. et al. Morphomolecular classification update on hepatocellular adenoma, hepatocellular carcinoma, and intrahepatic cholangiocarcinoma. Radiographics 2022; 42 (05) 1338-1357
• 9 El-Serag HB. Hepatocellular carcinoma. N Engl J Med 2011; 365 (12) 1118-1127
• 10 Baffy G, Brunt EM, Caldwell SH. Hepatocellular carcinoma in non-alcoholic fatty liver disease: an emerging menace. J Hepatol 2012; 56 (06) 1384-1391
• 11 McGlynn KA, London WT. The global epidemiology of hepatocellular carcinoma: present and future. Clin Liver Dis 2011; 15 (02) 223-243, vii–x .
• 12 van Malenstein H, van Pelt J, Verslype C. Molecular classification of hepatocellular carcinoma anno 2011. Eur J Cancer 2011; 47 (12) 1789-1797
• 13 Taguchi K, Asayama Y, Aishima S. et al. Morphologic approach to hepatocellular carcinoma development in man: de novo or the so-called “dysplastic nodule-carcinoma” sequence?. Oncol Rep 2002; 9 (04) 737-743
• 14 Toyoda H, Hiraoka A, Uojima H. et al. Characteristics and prognosis of de novo hepatocellular carcinoma after sustained virologic response. Hepatol Commun 2021; 5 (07) 1290-1299
• 15 International Consensus Group for Hepatocellular NeoplasiaThe International Consensus Group for Hepatocellular Neoplasia. Pathologic diagnosis of early hepatocellular carcinoma: a report of the international consensus group for hepatocellular neoplasia. Hepatology 2009; 49 (02) 658-664
• 16 Terada T, Kadoya M, Nakanuma Y, Matsui O. Iron-accumulating adenomatous hyperplastic nodule with malignant foci in the cirrhotic liver. Histopathologic, quantitative iron, and magnetic resonance imaging in vitro studies. Cancer 1990; 65 (09) 1994-2000
• 17 Gurusamy K. Trace element concentration in primary liver cancers: a systematic review. Biol Trace Elem Res 2007; 118 (03) 191-206
• 18 Fargion S, Valenti L, Fracanzani AL. Role of iron in hepatocellular carcinoma. Clin Liver Dis (Hoboken) 2014; 3 (05) 108-110
• 19 Inui S, Kondo H, Tanahashi Y. et al. Steatohepatitic hepatocellular carcinoma: imaging findings with clinicopathological correlation. Clin Radiol 2021; 76 (02) 160.e15-160.e25
• 20 Salomao M, Remotti H, Vaughan R, Siegel AB, Lefkowitch JH, Moreira RK. The steatohepatitic variant of hepatocellular carcinoma and its association with underlying steatohepatitis. Hum Pathol 2012; 43 (05) 737-746
• 21 Olofson AM, Gonzalo DH, Chang M, Liu X. Steatohepatitic variant of hepatocellular carcinoma: a focused review. Gastroenterol Res 2018; 11 (06) 391-396
• 22 Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol 2000; 33 (02) 282-289
• 23 Park YN, Yang CP, Fernandez GJ, Cubukcu O, Thung SN, Theise ND. Neoangiogenesis and sinusoidal “capillarization” in dysplastic nodules of the liver. Am J Surg Pathol 1998; 22 (06) 656-662
• 24 Kitao A, Matsui O, Yoneda N. et al. The uptake transporter OATP8 expression decreases during multistep hepatocarcinogenesis: correlation with gadoxetic acid enhanced MR imaging. Eur Radiol 2011; 21 (10) 2056-2066
• 25 Kogita S, Imai Y, Okada M. et al. Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow. Eur Radiol 2010; 20 (10) 2405-2413
• 26 Vij M, Calderaro J. Pathologic and molecular features of hepatocellular carcinoma: an update. World J Hepatol 2021; 13 (04) 393-410
• 27 Torbenson MS. Hepatocellular carcinoma: making sense of morphological heterogeneity, growth patterns, and subtypes. Hum Pathol 2021; 112: 86-101