CLINICOPATHOLOGICAL STUDIES OF MINUTE HEPATOCELLULAR CARCINOMA - ANALYSIS OF 20 CASES, INCLUDING 4 WITH HEPATIC RESECTION

Abstract

Sixteen necropsies and 4 cases of hepatic resection in which the liver had a solitary hepatocellular carcinoma smaller than 4.5 cm, or a few tumor nodules smaller than 3.5 cm, were analyzed. Clinically, these patients presented with signs and symptoms compatible with cirrhosis and, of the 16 autopsy cases only 2 were diagnosed correctly. In all but 4 cases, the noncancerous parenchyma showed advanced cirrhosis of the mixed type, with irreularly sized multilobular nodules and thin strands of stroma, different from typical alcoholic cirrhosis. The primary lesion was grossly encapsulated in the majority, suggesting a slow, expanding growth. Histologically, most primaries were relatively well differentiated. Serum .alpha.-fetoprotein was generally low, and it served as the major diagnostic clue in only 5 cases. In patients with mildly abnormal .alpha.-fetoprotein levels, continuous monitoring seems important to detect a steady rise, the 1st warning for tumor growth.