Small hepatocellular carcinoma with minute satellite nodules

Background/Aims: To investigate the clinicopathologic characteristics of sm all hepatocellular carcinoma with minute satellite nodules. Methodology: We investigated the clinicopathologic characteristics of 131 s olitary small (less than or equal to 2.0cm in diameter) hepatocellular carc inomas including 105 hepatocellular carcinomas without minute satellite nod ules and 17 hepatocellular carcinomas with minute satellite nodules smaller than 5mm, and also discuss the clinical significance. Results: None of the clinical backgrounds of the patients and pathologic fe atures of the main tumor, except for the average of preoperative serum alph a-fetoprotein, were significantly different between the two groups. Firstly , minute satellite nodules demonstrated that the maximum diameter of all mi nute satellite nodules was 1.5-4.0mm, secondly, the moderately to poorly di fferentiated hepatocellular carcinomas had 4 or more minute satellite nodul es within 1cm from the main tumor, while well differentiated hepatocellular carcinomas may have 1 or 2 minute satellite nodules 6cm or more away, and thirdly, 4 of more minute satellite nodules may present within 1cm in intra hepatic metastasis cases, while 1 or 2 minute satellite nodules may be pres ent 6cm of more away from the main tumor in multicentric occurrence cases. Conclusions: At least 13% of solitary small hepatocellular carcinomas had p reoperatively undetectable minute satellite nodules. In case of moderately to poorly differentiated hepatocellular carcinomas, hepatic resection as we ll as percutaneous ethanol injection should be performed including the surr ounding liver tissue at least 1.0cm from the main nodule. On the other hand , in well-differentiated hepatocellular carcinomas, which may indicate mult icentric occurrence, closer observation and careful follow-up after therapy are recommended.