Abstract
Many advances have been made in the imaging diagnosis and in the histopathological evaluation of HCC. However, the classic imaging and histopathological features of HCC are still inadequate to define patient’s prognosis. We aimed to find the link between new proposed morphovascular patterns of hepatocellular carcinoma (HCC) and magnetic resonance imaging (MRI) features to identify pre-operatory markers of biologically aggressive HCC. Thirty-nine liver nodules in 22 patients were consecutively identified. Histopathological analysis and immunohistochemistry for CD34 and Nestin were performed to identify the four different HCC morphovascular patterns. MRI was performed using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid. Three out of four morphovascular HCC patterns showed peculiar MRI features: in particular Pattern D (solid aggressive HCCs with CD34+/Nestin+ new-formed arteries) were isointense on T1-WI in 83% of cases and hyperintense on T2-WI in 50%. Five histologically-diagnosed HCC were diagnosed as non-malignant nodules on MRI due to their early vascularization and low aggressiveness (Pattern A). The comparison between histology and MRI confirms that a subclassification of HCC is possible in a pre-operatory setting. MRI seems to reinforce once more the identity of the different morphovascular HCC patterns and the possibility to pre-operatively identify HCCs with features of biological aggressiveness.
Highlights
In the Barcelona Clinic Liver Cancer (BCLC) staging for hepatocellular carcinoma (HCC) patients a wide prognostic range is observed, especially in group B patients[5]
The aim of the present study is to find the link between the morphovascular HCC patterns and the corresponding imaging features, with the purpose to find a pre-operatory picture of those advanced HCC with biological and morphological features of aggressiveness
Gd-EOB-DTPA was developed as hepatobiliary magnetic resonance imaging (MRI) agent back in 1992, and used to classify HCC
Summary
In the Barcelona Clinic Liver Cancer (BCLC) staging for HCC patients a wide prognostic range is observed, especially in group B (intermediate) patients[5]. For this reason, some authors tried to subclassify BCLC group B www.nature.com/scientificreports/. Patients[6,7], but none of the proposed subclassifications considered the biology and the pathology of HCCs, eHCCs and HGDNs. A recent experience of the Pathology Unit of our Institution showed that it is possible to sort HCCs according to their morphovascular pattern, i.e. the tumor architecture and the maturity of intratumoral sinusoids and neoarteries[8]. Our purpose is not to come back to perform the biopsy of every nodules in a cirrhotic background, but to identify, the tumor biological differences to correctly stratify the patients with HCC in the preoperative setting
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