Non-Asian hepatocellular carcinoma: correlation between histologic features and echogenicity

Studies of hepatocellular carcinoma in Asia have revealed a correlation between lesion hyperechogenicity and five histologic features: nonliquefied necrosis, sinusoidal dilatation, hemorrhage, fatty metamorphosis, and fibrosis. However, this correlation has not been investigated for non-Asian hepatocellular carcinoma, despite substantial differences between the Asian and non-Asian forms of this carcinoma. We retrospectively reviewed records of 29 patients seen at one United States institution who had hepatocellular carcinoma lesions that were either completely hyperechoic or completely hypoechoic. Tissue specimens obtained surgically (n = 7) or percutaneously (n = 22) were evaluated microscopically for the presence of nonliquefied necrosis, sinusoidal dilatation, hemorrhage, fatty metamorphosis, and fibrosis. A statistically significant correlation was identified between the number of histologic features identified and lesion diameter (P = 0.04) but not between the number of histologic features identified and the likelihood of hyperechogenicity (P = 0.11). Two lesions (50%) with three histologic features, four lesions (40%) with two histologic features, and six lesions (55%) with one histologic feature were hypoechoic. The echogenicity of non-Asian hepatocellular carcinoma lesions cannot be attributed to the histologic features that are believed to underlie echogenicity of the Asian type of hepatocellular carcinoma.