Hepatocellular carcinoma (HCC) typically arises in a chronically diseased or cirrhotic liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy and is the most common primary liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy cancer. Diagnosis may include ultrasound, CT, MRI, biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma (if inconclusive imaging), and/or biomarkers. Treatment options include resection and chemo-/radiotherapy, and liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy transplantation in select cases. Liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy metastases are much more common than primary liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy cancers and usually originate from colorectal, lung, breast, and pancreatic primary sites. Metastases are most commonly diagnosed by CT or PET PET An imaging technique that combines a positron-emission tomography (PET) scanner and a ct X ray scanner. This establishes a precise anatomic localization in the same session. Nuclear Imaging scans. Management depends on the type and stage of primary cancer.
Last updated: 10 Sep, 2021
Cirrhosis Cirrhosis Cirrhosis is a late stage of hepatic parenchymal necrosis and scarring (fibrosis) most commonly due to hepatitis C infection and alcoholic liver disease. Patients may present with jaundice, ascites, and hepatosplenomegaly. Cirrhosis can also cause complications such as hepatic encephalopathy, portal hypertension, portal vein thrombosis, and hepatorenal syndrome. Cirrhosis:
One-third of patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with cirrhosis Cirrhosis Cirrhosis is a late stage of hepatic parenchymal necrosis and scarring (fibrosis) most commonly due to hepatitis C infection and alcoholic liver disease. Patients may present with jaundice, ascites, and hepatosplenomegaly. Cirrhosis can also cause complications such as hepatic encephalopathy, portal hypertension, portal vein thrombosis, and hepatorenal syndrome. Cirrhosis will develop HCC during their lifetime, including those caused by:
Other:
Hepatocytes Hepatocytes The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. Liver: Anatomy show “large-cell change” and “small-cell change” with abnormal architecture (thick trabeculae) microscopically.
Gross appearance:
Microscopic appearance:
Histology of a normal
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy:
microphotograph of a normal
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy with a dilated central vein but normal architecture showing thin (single-cell layer) trabeculae (trichrome stain, 100x)
Histology of hepatocellular carcinoma (HCC):
microphotograph of a moderately differentiated HCC showing pattern of thickened (2–6 cell layers) trabeculae surrounded by flattened endothelial cells. Note the brown
bile
Bile
An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts; cholesterol; and electrolytes. It aids digestion of fats in the duodenum.
Gallbladder and Biliary Tract: Anatomy pigment in the top left and the 2 large pseudoglandular spaces containing pink proteinaceous material. The
hepatocytes
Hepatocytes
The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules.
Liver: Anatomy show moderate
atypia
Atypia
Fibrocystic Change. Compare the thickened trabeculae to the single-cell trabeculae in a normal
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy.
Four possible clinical presentations for HCC:
Surveillance Surveillance Developmental Milestones and Normal Growth screening Screening Preoperative Care by ultrasound every 6 months is recommended for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship in the following high-risk groups:
Hepatocellular carcinoma (HCC) on ultrasound: ultrasound images of HCC in the
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy of a 31-year-old man with
cirrhosis
Cirrhosis
Cirrhosis is a late stage of hepatic parenchymal necrosis and scarring (fibrosis) most commonly due to hepatitis C infection and alcoholic liver disease. Patients may present with jaundice, ascites, and hepatosplenomegaly. Cirrhosis can also cause complications such as hepatic encephalopathy, portal hypertension, portal vein thrombosis, and hepatorenal syndrome.
Cirrhosis
B1: conventional ultrasound showing the
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast as a poorly defined,
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography)
nodule
Nodule
Chalazion
B2, B3, B4: time-sequenced contrast-enhanced ultrasound (CEUS) images after injection of a microbubble contrast agent
B2: typical hypervascularity (enhancement) of HCC during the arterial phase at 95 sec after injection of the contrast agent
B3, B4:
mass
Mass
Three-dimensional lesion that occupies a space within the breast
Imaging of the Breast becoming
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography) in the portal and late phases
B4: late-phase image showing mild washout of contrast medium at 179 sec, which helps differentiate HCC from
cholangiocarcinoma
Cholangiocarcinoma
A malignant tumor arising from the epithelium of the bile ducts.
Rare Malignant Liver Tumors or metastatic
tumor
Tumor
Inflammation (more rapid washout times)
If ultrasound shows a lesion > 1 cm, dynamic contrast imaging by CT or MRI is performed.
Hepatocellular carcinoma (HCC) on computed tomography (CT):
triphasic abdominal CT revealing a large
tumor
Tumor
Inflammation (4.8 cm in diameter) in the right lobe compatible with HCC (arrow)
Typical magnetic resonance imaging (MRI) characteristics of hepatocellular carcinoma (HCC):
axial
Axial
Computed Tomography (CT) MRI of the
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy after intravenous (IV) administration of a hepatocyte-specific contrast agent in arterial (left) and hepatobiliary (right) phases 20 min after IV contrast application
In segment 6, a hypervascular lesion is observed (left image, arrow pointing to the lesion).
In the hepatobiliary phase, the lesion (right image, arrow pointing to the lesion) is
hypointense
Hypointense
Magnetic Resonance Imaging (MRI) in relation to the surrounding
liver
Liver
The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood.
Liver: Anatomy secondary to reduced uptake of contrast agent due to loss of functioning
hepatocytes
Hepatocytes
The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules.
Liver: Anatomy in the poorly differentiated HCC lesion.
If imaging results are unequivocal, a biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma is not always needed.
Gross specimen of the liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy showing multiple metastatic tumors
Image: “Secondary tumor Tumor Inflammation deposits in the liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy from a primary cancer of the pancreas Pancreas The pancreas lies mostly posterior to the stomach and extends across the posterior abdominal wall from the duodenum on the right to the spleen on the left. This organ has both exocrine and endocrine tissue. Pancreas: Anatomy” by John Hayman. License: Public DomainThe following are important differential diagnoses of a solid mass Mass Three-dimensional lesion that occupies a space within the breast Imaging of the Breast in the liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy:
Benign Benign Fibroadenoma lesions:
Malignant lesions:
Cholangiocarcinoma Cholangiocarcinoma A malignant tumor arising from the epithelium of the bile ducts. Rare Malignant Liver Tumors ( bile Bile An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts; cholesterol; and electrolytes. It aids digestion of fats in the duodenum. Gallbladder and Biliary Tract: Anatomy duct cancer): arises from epithelial cells of the intrahepatic and extrahepatic bile Bile An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts; cholesterol; and electrolytes. It aids digestion of fats in the duodenum. Gallbladder and Biliary Tract: Anatomy ducts. Risk factors in the United States include primary sclerosing cholangitis Primary Sclerosing Cholangitis Primary sclerosing cholangitis (PSC) is an inflammatory disease that causes fibrosis and strictures of the bile ducts. The exact etiology is unknown, but there is a strong association with IBD. Patients typically present with an insidious onset of fatigue, pruritus, and jaundice, which can progress to cirrhosis and complications related to biliary obstruction. Primary Sclerosing Cholangitis and fibropolycystic liver Liver The liver is the largest gland in the human body. The liver is found in the superior right quadrant of the abdomen and weighs approximately 1.5 kilograms. Its main functions are detoxification, metabolism, nutrient storage (e.g., iron and vitamins), synthesis of coagulation factors, formation of bile, filtration, and storage of blood. Liver: Anatomy disease (e.g., choledochal cysts Cysts Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues. Fibrocystic Change). Hepatolithiasis Hepatolithiasis Rare Malignant Liver Tumors (recurrent pyogenic cholangitis) is the biggest risk factor for cholangiocarcinoma Cholangiocarcinoma A malignant tumor arising from the epithelium of the bile ducts. Rare Malignant Liver Tumors in Asia ASIA Spinal Cord Injuries.