SYNCHRONOUS MULTICENTRIC DEVELOPMENT OF HEPATOCELLULAR-CARCINOMA

Recently, the multicentric origin of hepatocellular carcinoma (HCC) ha s been recognized, but its clinical importance has still not yet been clarified. The histological characteristics of small hyperechoic HCCs coexisting in 44 consecutively resected Japanese patients whose main H CCs were <5.0 cm in size were studied. Twelve small hyperechoic HCCs w ere found and classified into the following two groups: eight nodules in seven patients (15.9%) were early-stage HCC, and four nodules in fo ur patients (9.1%) were more advanced HCC. Thus, early-stage HCC compr ised 66.7% of the small echogenic HCCs. Eight HCCs detected as small h yperechoic lesions (found in 15.9% of the patients) showed varying deg rees of fatty change yet proved to be well differentiated and retained the preexisting liver structure of either associated liver cirrhosis or chronic hepatitis. Moreover, the histologic characteristics of the eight early-stage HCCs were different from those of the main HCCs. In conclusion, similar to 15% of HCCs in Japanese patients may have a syn chronous multicentric origin, and small hyperechoic lesions should be carefully evaluated. However, in the United States or other areas wher e the occurrence of fatty liver is common, that advice for small hyper echoic lesions may be overly cautious.