[Capsule formation in hepatocellular carcinomas arising from liver cirrhosis]

70-80% of hepatocellular carcinoma arise from liver cirrhosis. Therefore early diagnostic attempts to identify hepatic carcinoma appear to be mandatory. In 345 patients with liver cirrhosis the following examinations were routinely performed on several occasions: alpha-fetoprotein, ultrasound, scintigraphy, CT scan, angiography, laparoscopy or ultrasound directed biopsy of the liver. The sex ratio of 4:1 (m:f) revealed a clearly higher incidence of hepatocellular carcinoma in men. The peak incidence occurred between age 55 and 59. In our study the diagnosis of liver cirrhosis was established in a group of 345 patients during a period of 7 years. Two years later primary liver cell carcinoma had developed in 37 patients. By ultrasonographic or CT examination in 36 patients the tumor appeared nodular with a nodule size between 1 and 3 cm, while in 1 patient a diffuse pattern was found. Forming capsules in the liver (77%) often was the first sign that a tumor existed and seems to be characteristic for hepatocellular carcinomas. 63% of tumors are found within the right hepatic lobe, 27% within the left lobe and 10% occur in both. In further studies complications of hepatocellular carcinomas were examined. 10 out of 33 patients died of intraabdominal bleeding due to decay of the tumor perfused with chemotherapeutic agents prior to the event. A possible form of therapy of hepatocellular carcinoma in early stage appears to be arterial embolisation.