Primary hepatocellular carcinoma: clinical, ultrasonic, and pathological patterns and correlations

Twenty-seven patients with tissue diagnosis of hepatocellular carcinoma were reviewed retrospectively in an attempt to do a correlative study between clinical echographic patterns and the pathologic grading. The mean of the anterior hepatic linear projection (AHLP) was 33 cm; the surface was smooth in 26% and irregular in 30% and a single mass was detected in 44% of cases. Ultrasonically, three patterns were detected: 1) solitary mass in 66.6% of cases: hyperechogenicity in 22.2%, hypoechogenicity in 27.8%, and compound echogenicity in 50% of cases; 2) multiple masses in 25.9% of cases: hyperechogenicity in 71.4% and compound echogenicity in 28.6%; and 3) diffuse distortion of hepatic architecture with areas of heterogenous echopattern in 7.4% of cases. Pathological grading was carried out according to the generally accepted criteria, grades I in 29.6%, II in 33.3%, and III in 37.1% of cases. No correlation could be detected between the AHLP, patient age, sex, duration of complaint, or incidence of distant metastases and the pathologic grading. Also, there was no correlation between the duration of complaint and the AHLP. However, a significant relation was detected between the character of the hepatic surface and the pathologic grading; a smooth liver was associated with lower pathologic grading compared to either the surface with a single mass or to the irregular surface. On the other hand, no significant relation could be detected between lobar affection, ultrasonic pattern, or echogenicity and the pathologic grading.