Role of Vascular Liver Diseases in Hepatocellular Carcinoma Development

Hepatocellular carcinoma (HCC) is a frequent complication of various liver diseases, occurring with or without underlying cirrhosis. While cirrhosis and chronic liver inflammation are well-established major drivers of hepatocarcinogenesis, HCC can also develop in patients with vascular liver diseases (VLDs), highlighting an alternative pathway of disease progression. Alterations in liver perfusion appear to underlie the process of carcinogenesis. However, the specific molecular mechanisms involved in this process as well as the clinical presentation and imaging features of HCC in the most common VLDs are still a matter of debate. This review aims to evaluate the available literature on the topic to provide a deeper comprehension and analysis of current knowledge about the relation between VLDs and HCC. Specifically, we investigate how HCC affects VLDs such as Budd-Chiari syndrome, Fontan-associated liver disease, congenital portosystemic shunts, cavernous transformation of the portal vein, and porto-sinusoidal vascular disorder. Exploring the pathogenetic mechanisms and diagnostic challenges in HCC related to VLDs may have important therapeutic implications, helping to define targeted treatments for this poorly understood medical entity.