Hepatocellular carcinoma (HCC) in non-cirrhotic liver: clinical, radiological and pathological findings

Our aim was to evaluate the clinical and pathological findings, mutidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI) appearances, treatment and 1-year survival of patients with HCC in non-cirrhotic liver.

Histopathological and laboratory findings of 30 non-cirrhotic patients with 32 HCCs were reviewed retrospectively. MDCT and gadobenate dimeglumine-enhanced MR images were evaluated in consensus by two radiologists in terms of HCC size, presence of tumour capsule, necrosis, haemorrhage, fat and calcification, and vascular involvement. Imaging patterns were compared directly with HCC findings in a matched group of cirrhotic patients.

No differences between non-cirrhotic and cirrhotic patients were noted in terms of serum α-fetoprotein levels (elevated in 11 [36.7%] and 21 [35%] patients, respectively). The imaging appearance at CT and contrast-enhanced MRI was typical in 27 (84.3%) and 28 (87.5%) cases respectively. Most lesions presented as a well-differentiated large solitary mass, with well-defined margins, areas of necrosis and peripheral capsule. No significant differences in HCC pattern were observed between cirrhotic and non-cirrhotic liver.

In non-cirrhotic patients, HCC is more likely to manifest as an asymptomatic mass with elevation of serum tumour markers similar to that seen in cirrhotic patients. HCC in cirrhotic and non-cirrhotic livers show similar enhancement patterns.

HCC shows similar CT/MRI pattern in cirrhotic and non-cirrhotic livers. Non-invasive diagnostic criteria for HCC should also be extended to non-cirrhotic livers. No differences were found between α-fetoprotein levels in non-cirrhotic and cirrhotic patients.