Well-differentiated hepatocellular carcinoma: clinicopathological features and results of hepatic resection

To clarify clinicopathological features and surgical results in patients with well-differentiated hepatocellular carcinoma (wd-HCC) corresponding to Edmondson's cell grading I/I-II.

The clinicopathological characteristics, diagnosis, and results of surgery were studied in 14 wd-HCC patients who underwent limited hepatic resection.

All patients had liver cirrhosis and solitary tumors. The tumor sizes ranged from 10 to 25 mm. Serum alpha-fetoprotein levels were normal in 13 patients. The detection rates of sonography, computed tomography (CT), angiography, CT during arterial portography, 1-wk lipiodol CT, and 3-wk lipiodol CT were 100%, 43%, 36%, 69%, 57%, and 0%, respectively. High echoic pattern on sonography and disappearance of lipiodol 3 wk after injection were characteristic findings. There was no operative death. Although seven patients developed intrahepatic tumor recurrence, early treatment including ethanol injection therapy and arterial embolization/infusion therapy controlled the recurrences in five patients. Eleven patients are surviving 25-83 mo after surgery (mean, 44 mo); the remaining three died of pneumonia or hepatic insufficiency 44-62 mo after surgery. Eight patients received successful direct interruption surgery for concurrent esophagocardia varices. Pathological features of wd-HCCs included lack of tumor invasiveness or capsule, nuclear crowding, microacinar formation, fat deposition, presence of portal tracts, and surrounding adenomatous hyperplasia.

Wd-HCCs present atypical findings in various imagings and histology because of the earlier developmental stage of HCCs. Hepatic resection for wd-HCCs provides excellent patient survival.