Hepatic malignancies: Correlation between sonographic findings and pathological features

Ultrasonography (US) findings are inevitably based on pathological features. Knowledge of the pathological features of hepatic malignancies such as hepatocellular carcinoma (HCC), liver metastasis and intrahepatic cholangiocarcinoma is essential for correct US diagnosis and appropriate management. One type of hepatocarcinogenesis is step-wise development from a low-grade dysplastic nodule (DN), high-grade DN, high-grade DN with malignant foci, and well-differentiated HCC, to classical HCC. The intranodular blood supply changes in accordance with this progression. Moreover, the malignant potential tends to change as the macroscopic configuration progresses. Therefore, typical US findings of advanced HCC are a mosaic pattern, septum formation, peripheral sonolucency (halo), lateral shadow produced by fibrotic pseudocapsule, posterior echo enhancement, arterial hypervascularity with dilated intratumoral blood sinusoids, and perinodular daughter nodule formation. Bull's eye appearance is a common presentation of metastases from gastrointestinal (GI) adenocarcinomas, and represents histological findings that show an area of central necrosis surrounded by a zonal area of viable tumor. Thick zonal area reflects the layer of viable cells that are fed by minute tumor vessels. US imaging features of liver metastases from the GI tract are as follows: Bull's eye appearance, multiple masses, irregular tumor border, arterial rim-like enhancement, and hypoenhancement in the late vascular phase. Most intrahepatic cholangiocarcinomas are ductal adenocarcinomas. The bile ducts peripheral to the tumor are usually dilated because of obstruction by tumors. US imaging features of mass-forming cholangiocarcinoma are as follows: peripheral bile duct dilatation, irregular tumor border, arterial enhancement due to minute intratumoral blood sinusoids, and hypoenhancement in the late vascular phase.