Carcinoma In Non-cirrhotic Liver Research Articles

Long-term follow-up after resection of thyroid metastases from hepatocellular carcinoma in noncirrhotic liver

Thyroid metastasis from hepatocellular carcinoma (HCC) is rare, and has poor prognosis. We report the case of a 62-year-old woman seen at our clinic because of the occurrence of a slightly painful abdominal mass. At that time, alpha-fetoprotein concentration was very high, reaching 49,831.7 ng/mL. Abdominal ultrasound showed a heterogeneous mass in segment IV of the liver, which was diagnosed as HCC upon MRI. The patient underwent surgical resection and histological analysis of the specimen confirmed HCC. Metastases to the thyroid were detected 17 months after liver resection. Although the presence of metastases indicates advanced disease, thyroidectomy was performed, since no other distant metastases were detected. In fact, the patient is doing well 3 years after thyroidectomy and regular imaging exams showed no tumor recurrence. Current alpha-fetoprotein concentration is 8 ng/mL. In conclusion, thyroid metastasis from HCC is uncommon and short-term survival is expected. However, surgical resection should be encouraged, especially in the case of solitary metastases.

Increased Alpha-Fetoprotein Serum Level is Predictive for Survival and Recurrence of Hepatocellular Carcinoma in Non-Cirrhotic Livers

Background: Hepatocellular carcinoma (HCC) may be diagnosed in the absence of cirrhosis. However, little is known about prognostic factors for the survival of HCC patients with a non-cirrhotic liver in the absence of well-established risk factors. Method: Survival rates and risk factors for survival and recurrence were analysed in all patients diagnosed between 2000 and 2010 with HCC in a non-cirrhotic liver and in the absence of well-established risk factors. Results: Ninety-four patients were analysed. Treatment with curative intent consisted of surgical resection in 43 patients (46%) and radiofrequency ablation in 4 patients (4%). In patients treated with curative intent and alive 30 days after treatment (n = 40), 1- and 5-year overall survival rates were 95 and 51%, respectively. Patients with a high preoperative α-fetoprotein (AFP) serum level, the presence of microvascular invasion in the resected specimen, a complicated postoperative course and a major resection, due to a greater tumour volume, had a significantly worse outcome and a higher recurrence rate. In multivariate analysis, a high AFP serum level at presentation was significantly associated with recurrence and a worse survival. Conclusion: HCC presenting in a non-cirrhotic liver in the absence of well-established risk factors has a poor prognosis. Increased AFP serum levels are significantly associated with clinical outcome.

Long-term results of liver resection for hepatocellular carcinoma in noncirrhotic liver

Hepatocellular carcinoma (HCC) is among the most common malignant neoplasms worldwide. Only few data on HCC in noncirrhotic livers without viral hepatitis in Western countries are available. The purpose of this study was to define the outcomes and potential prognostic factors associated with survival after hepatic resection in patients with HCC in the absence of liver cirrhosis and hepatitis B or C infection. From January 2000 to September 2010, 148 patients without liver cirrhosis and without extrahepatic metastases underwent curative hepatic resection for HCC at the Surgical Department of the Charité, Campus Virchow Klinikum. The outcomes of these patients were retrospectively reviewed. Patients with cirrhosis or severe fibrosis, fibrolamellar HCC, and those positive for hepatitis B or C were excluded. The cumulative 1-, 3-, 5-, and 7-year survival rates were 75.4%, 54.7%, 38.9%, and 31.8%, respectively. The 1-, 3-, 5-, and 7-year disease-free survival rates were 60.3%, 38.0%, 29.1%, and 18.1%, respectively. In the multivariate analysis, cumulative survival was decreased by patient age, increased operative time, increased preoperative serum gamma-glutamyl transferase (GGT), and tumor stage. In the subgroup with unifocal neoplasms, N0 and R0 status, tumor size >10 cm, and tumor differentiation were highly predictive of lesser survival. Unfavorable survival was observed in patients with multifocal neoplasms, tumor size >10 cm, and/or poor tumor differentiation. The current TNM staging system is stratified for survival and recurrence. Extension of the current TNM staging system by grading and more exact differentiation of tumor size may increase its prognostic accuracy for predicting outcome. Preoperative increased serum GGT level could be a new poor prognostic factor.

Hepatocellular carcinoma in patients without cirrhosis in Italy

BackgroundIn the Western world, hepatocellular carcinoma seldom develops in patients without cirrhosis, and reports describing the characteristics of non-cirrhotic patients with hepatocellular carcinoma are rather infrequent. MethodsWe evaluated the main clinical characteristics, treatment options, and survival of patients with hepatocellular carcinoma developed in non-cirrhotic liver among the 3027 consecutive cases of hepatocellular carcinoma accrued in the Italian Liver Cancer database during the last 20 years. ResultsWe identified 52 patients with hepatocellular carcinoma in non-cirrhotic livers (1.7% of all hepatocellular carcinomas), 42 with (80.8%) and 10 without (19.2%) chronic liver disease. In patients without chronic liver disease, median tumour diameter was greater compared to patients with chronic liver disease (7.8 versus 4.0cm, P=0.046). Curative treatment was feasible in 20 patients (38.5%). Median overall survival was 26 months and 5-year survival rate was 23.7%. Detection of hepatocellular carcinoma outside surveillance (P=0.036), advanced hepatocellular carcinoma stage (P<0.0001), and non-curative treatment (P=0.007) were associated with worse prognosis, but tumour stage was the only independent predictor of survival. ConclusionsIn Italy, less than 2% of hepatocellular carcinomas develop in a non-cirrhotic liver, and almost never in a normal liver. These patients frequently present with advanced tumours, have low eligibility rates for curative treatment, and have a dismal prognosis despite their preserved liver function.

Tumor size of hepatocellular carcinoma in noncirrhotic liver: A controversial predictive factor for outcome after resection

BackgroundHepatocellular carcinoma in noncirrhotic liver (NC-HCC) presents usually with large size, which is seen as a contraindication to liver transplantation (LT) or even resection. The objective of our single-center study was to identify prognostic factors following resection of large NC-HCCs and to subsequently devise a treatment strategy (including LT) in selected patients. MethodsFrom 2000 to 2010, 89 patients who had hepatic resection for NC-HCC (large ≥8 cm in 52) were analyzed with regard to pathological findings, postoperative and long-term outcome. ResultsFive patients died postoperatively. After a mean follow-up of 35 ± 30 months, NC-HCC recurred in 36 patients (26/47 survivors in group 8 cm+, 10/37 in group 8 cm−; p = 0.007). Five-year overall (OS) and disease-free survival (DFS) rates were significantly worse for group 8 cm+ (43.4% vs. 89.2% and 39.3% vs. 60.7% for group 8 cm−, p < 0.05). Seven patients underwent re-hepatectomy and/or LT for isolated intrahepatic recurrence, with 5-year DFS of 57.1%. In a multivariate analysis, the factors associated with poor OS and DFS were vascular invasion and tumor size ≥8 cm in the overall population and vascular invasion, fibrosis and satellite nodules in group 8 cm+. Adjuvant transarterial chemotherapy was a protective factor in group 8 cm+. In 22 isolated NC-HCC cases with no vascular invasion or fibrosis, tumor size had no impact on five-year DFS (85%). ConclusionsAlthough patients with NC-HCC ≥8 cm had a poorer prognosis, the absence of vascular invasion or fibrosis was associated with excellent survival, regardless of the tumor size. In recurrent patients, aggressive treatment (including LT) can be considered.

Prognostic factors and outcomes of patients with hepatocellular carcinoma in non-cirrhotic liver

Objectives. To report the outcome of patients with hepatocellular carcinoma (HCC) in non-cirrhotic liver depending on the mode of primary treatment and to define clinicopathological factors influencing patients' prognosis. Methods. A retrospective analysis of an unselected cohort of 105 patients was performed. Overall survival (OS) was estimated by the Kaplan–Meier method and potentially prognostic factors were analyzed in Cox regression models. Results. OS of the whole cohort at 1, 3, and 5 years was 66%, 47%, and 29%, respectively. Tobacco consumption, ECOG >0, macroscopic vascular invasion, continuous tumor diameter, and treatment other than resection were predictors of decreased OS in the whole cohort. Resection was performed in 64% of patients with 1-, 3-, and 5-year OS rates of 84%, 69%, and 42%, respectively. Siderosis and BCLC stage were associated with decreased OS after resection. Recurrence occurred in 57% of patients with 1-, 3-, and 5-year disease-free survival (DFS) rates of 63%, 39%, and 31%, respectively. Viral hepatitis and macroscopic vascular invasion were associated with decreased DFS. One-, 3-, and 5-year OS rates in patients with non-surgical approaches (transarterial chemoembolization, systemic therapy, best supportive care) were 38%, 11%, and 7%, respectively. Tobacco consumption and Okuda stage were associated with decreased OS in these patients. Conclusions. OS and DFS of patients with HCC in non-cirrhotic liver depend most notably on tumor-related, demographic, and etiological factors. Features of the non-neoplastic liver tissue play only a minor role. Liver resection leads to a significantly better prognosis than non-surgical treatment approaches.

Hepatocellular Carcinoma in Non-cirrhotic Liver Without Evidence of Iron Overload in a Patient with Primary Hemochromatosis. Review

We report a case of a 70-year-old male with hepatocellular carcinoma (HCC) with a history of hemochromatosis but with no evidence of cirrhosis or iron overload and with a history of exposure to atomic bomb radiation. It is very rare to see hepatocellular carcinoma in the absence of evidence of liver injury. We did an extensive review of current English medical literature through Pubmed from 1980 to 2009 and found 14 case reports of patient with hepatocellular cancer in absence of cirrhosis. The details of these cases were reanalyzed as reported and documented for review. There are 14 previous case reports of HCC developing in hemochromatosis in absence of cirrhosis but ten of them had evidence of iron overload in the non-tumorous livers. Our case is the fifth case of Hepatocellular cancer in hemochromatosis in absence of cirrhosis and iron overload. Hepatocellular carcinoma is a very rare in absence of cirrhosis but patient with other risk factors like hemochromatosis, viral infections, radiation, and toxin exposure should be monitored closely for any sign and symptoms suggestive of malignancy.

Factores pronósticos del hepatocarcinoma en el hígado no cirrótico tras su resección: presentación de 51 casos

Background Clinical presentation, treatment and prognosis of hepatocellular carcinoma depend on presence or absence of cirrhosis. In the literature there are few reports of hepatocellular carcinoma in non-cirrhotic patients. Objective To describe a consecutive series of resected patients with hepatocellular carcinoma in non-cirrhotic liver and to identify prognostic factors of recurrence and survival. Material and methods Between 1990 and 2006, 51 patients were operated on. Data were retrospectively analysed from a prospectively collected database. Single and multivariate analyses were performed to identify factors associated with survival and disease-free survival. Results Thirty-three patients were male, median age 49.8 years. A major hepatectomy was performed in 72%. Morbidity was 43% and mortality was 0%. One-, two- and three-year survival rates were 90%, 75% and 67%, respectively. One-, two- and three-year disease-free survival rates were 65%, 41% and 37%, respectively. Presence of vascular invasion and of positive nodes was statistically significant for survival in univariate analysis but had no statistical significance in multivariate analysis. Conclusions Major hepatic resection is a safe treatment for hepatocellular carcinoma in non-cirrhotic patients. Both vascular invasion and presence of positive nodes were associated with poor survival. However, neither of them represented an independent variable.

Prognostic factors after resection of hepatocellular carcinoma in the non-cirrhotic liver: Presentation of 51 cases

BackgroundClinical presentation, treatment and prognosis of hepatocellular carcinoma depend on the presence or absence of cirrhosis. In the literature there are few reports of hepatocellular carcinoma in non-cirrhotic patients. ObjectiveTo describe a consecutive series of resected patients with hepatocellular carcinoma in non-cirrhotic liver and to identify prognostic factors of recurrence and survival. Material and methodsBetween 1990 and 2006, 51 patients were operated on. Data were collected retrospectively until 2001 and prospectively from then on. The results of surgery were assessed. Single and multivariate analyses were performed to identify factors associated with survival and disease-free survival. ResultsThirty-three patients were male, median age 49.8 years. A major hepatectomy was performed in 72%. Morbidity was 43% and mortality was 0%. One-, two- and three-year survival rates were 90%, 75%, and 67%, respectively. One-, two- and three-year disease-free survival rates were 65%, 41%, and 37%, respectively. Presence of vascular invasion and of positive nodes was statistically significant for survival in univariate analysis but had no statistical significance in multivariate analysis. ConclusionsMajor hepatic resection is a safe treatment for hepatocellular carcinoma in noncirrhotic patients. Both vascular invasion and presence of positive nodes were associated with poor survival. However, neither of them represented an independent variable.

Hepatocellular carcinoma in non-cirrhotic liver: A reappraisal

Although not frequently, hepatocellular carcinoma (HCC) can ensue in a non-cirrhotic liver. As compared to cirrhotic HCC, this kind of tumour has some peculiarities, such as: (a) a lower male preponderance and a bimodal age distribution; (b) a lower prevalence of the three main risk factors (hepatitis B and C virus infections and alcohol abuse), with an increased prevalence of other etiologic factors, such as exposure to genotoxic substances and sex hormones, inherited diseases, genetic mutations; (c) a more advanced tumour stage at the time of diagnosis, as it is usually detected due to the occurrence of cancer-related symptoms, outside any scheduled surveillance program; (d) a much higher amenability to hepatic resection, due to the low risk of liver failure even after extended parenchymal mutilation; (e) overall and disease-free survivals after resection of non-advanced tumours (meeting the Milano criteria) comparable to that obtained with liver transplantation in cirrhotic patients carrying an early tumour; (f) overall survival strictly dependent on tumour burden (and its recurrence) and barely influenced by liver function.

Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver

Background To evaluate the triple-phase CT findings for the differentiation of fat-deficient angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver. Methods We retrospectively reviewed contrast-enhanced triple-phase CT images of 10 patients with fat-deficient hepatic angiomyolipoma and 28 patients with 29 hepatocellular carcinomas in non-cirrhotic liver proved on histologic examination. The CT findings for the two types of tumors were compared using Fisher's exact test. Results Early draining vein depicted on arterial or portal phases was seen in eight (80%) angiomyolipomas and two hepatocellular carcinomas (7%) ( p < 0.001), in which the early draining vein was connected with tumoral vessels. The tumoral vessels in the angiomyolipoma were more prominent and ectatic, were distributed both centrally and peripherally, and were seen in smaller tumors than in the hepatocellular carcinoma. Tumor capsule enhancement was absent in all angiomyolipomas as compared with two (7%) hepatocellular carcinomas with no tumor capsule ( p < 0.001). The other CT findings were not significantly different for the two different types of tumors. Conclusions The presence of early draining vein connecting with prominent tumoral vessels and absent tumor capsule were useful CT findings for the differentiation of fat-deficient angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver.

Systemic chemotherapy for hepatocellular carcinoma in non-cirrhotic liver: A retrospective study

To investigate the efficacy and toxicity of systemic chemotherapy in a retrospective study of patients with hepatocellular carcinoma (HCC) occurring in normal or fibrotic liver without cirrhosis. Twenty-four patients with metastatic or locally advanced HCC in a normal or a fibrotic liver were given systemic chemotherapy (epirubicin, cisplatin and 5-fluorouracil or epirubicin, cisplatin and capecitabine regimens). Tumor response, time to progression, survival, and toxicity were evaluated. There were 7 women and 17 men, mean age 54 +/- 10 years; 18 patients had a normal liver and 6 had a fibrotic liver (F1/F2 on biopsy). Mean tumor size was 14 cm, 5 patients had portal vein thrombosis and 7 had metastasis. Patients received a median of 4 chemotherapy sessions. Overall tolerance was good. There were 5 partial responses (objective response rate = 22%), and tumor control rate was 52%. Second line surgical resection was possible in two patients. Median survival was 11 mo, and 1- and 2-year overall survival rates were 50% +/- 10% and 32% +/- 11%, respectively. In patients with HCC in a non-cirrhotic liver, chemotherapy was well tolerated and associated with an objective response rate of 22%, including two patients who underwent secondary surgical resection.

Clinicopathologic Features and Long-Term Outcomes of Chinese Patients with Hepatocellular Carcinoma in Non-Cirrhotic Liver

Background/Aims: Most hepatocellular carcinomas (HCC) are associated with cirrhosis. The clinicopathologic characteristics and outcomes of HCC present in non-cirrhotic livers are not well known in Chinese patients. This study was performed to explore the features of these patients and their outcomes after hepatectomy. Methods: 96 patients with histologically confirmed HCC in non-cirrhotic liver who underwent partial hepatectomy between 1995 and 2001 in our cancer center were reviewed. A retrospective analysis of the clinicopathologic features was performed, and survival of patients was analyzed by the Kaplan-Meier method and Cox regression model. Results: Operative mortality and morbidity were none and 8.3% (8/96), respectively. Postoperative overall survival (OS) rates at 1, 3, 5 and 10 years were 84.4, 62.5, 47.9 and 38.2%, respectively, with a median OS of 57 months. Disease-free survival (DFS) rates at 1, 3, and 5 years were 56.3, 39.6, and 33.3%, respectively, with a median DFS of 18 months. TNM stage was an independent prognostic factor for both OS and DFS of non-cirrhotic HCC. Operative blood loss was an independent prognostic factor for OS and DFS of patients who received curative resection. Conclusion: Curative partial hepatectomy was an effective and safe treatment for non-cirrhotic HCC. Aggressive local therapies were recommended for patients with intrahepatic recurrence.

Survival and Recurrence Rates after Resection for Hepatocellular Carcinoma in Noncirrhotic Livers

Survival and Recurrence Rates after Resection for Hepatocellular Carcinoma in Noncirrhotic Livers

Survival and Recurrence Rates after Resection for Hepatocellular Carcinoma in Noncirrhotic Livers

Hepatocellular carcinoma occurring in noncirrhotic livers is rare. The purpose of this article was to evaluate the outcomes and prognostic factors after hepatectomy in this setting. Between June 1998 and May 2005, 83 patients underwent liver resection for hepatocellular carcinoma in noncirrhotic livers at our institution. Preoperative treatment data, intraoperative details, pathologic findings, and information on tumor recurrence, treatment of recurrence, and survival were available for 80 of these patients. Postresection, the 3- and 5-year-survival rates were 48% and 30%, respectively. After R0 resection (n=66), the calculated 3- and 5-year-survivals were 54% and 39%, compared with 23% and 0%, respectively, after R1/2-resection (p<0.005). After a median followup of 25 months, tumor recurred in 40 of 63 (63%) patients after R0 resection. In univariate analysis, Union Internationale Contre le Cancer (UICC) stage, vascular invasion, and tumor grading were identified as important findings for recurrence and poor survival after R0 resection. For tumors without vascular invasion, the 3- and 5-year-survivals were 79% and 65%, respectively, which compared favorably with 21% and 7%, respectively, for tumors with vascular invasion (p<0.0001). Similarly, 3- and 5-year-survival rates (95% each) were considerably better for G1 tumors than the corresponding 36% and 22% rates in G2 and 60% and 30% in G3 tumors, respectively. The 3- and 5-year survivals of 54% and 39%, respectively, after R0 resections suggest that surgery is an option in hepatocellular carcinoma arising in noncirrhotic livers. Longterm results, however, are hampered by high recurrence rates. Union Internationale Contre le Cancer stage, vascular invasion, and tumor grades are predictors of tumor recurrence and diminished survival, and may help to identify candidates for potential adjuvant therapies.

P.388 HCV-related hepatocellular carcinoma in non-cirrhotic liver: immunohistochemical study of two cases

P.388 HCV-related hepatocellular carcinoma in non-cirrhotic liver: immunohistochemical study of two cases

Good Outcomes after Resection of Large Hepatocellular Carcinoma in the Non-Cirrhotic Liver

Background: The results of partial liver resection of hepatocellular carcinoma (HCC) in non-cirrhotic livers are not well known. Therefore a retrospective study was conducted. Methods: The medical records of 180 patients with HCC were reviewed. In 40 patients (22%), HCC occurred in a non-cirrhotic liver. A detailed analysis of these patients was performed. The diagnosis HCC was based on imaging and/or percutaneous ultrasound-guided biopsy. A biopsy of the remaining liver and peroperative findings documented the absence of cirrhosis. Results: Twenty-two patients underwent partial liver resection. There was no surgical mortality. The median tumour diameter in the operated patients was 10 cm. Survival rates for operated patients at 1 and 5 years were 96 and 68%, respectively. Significant factors reducing survival were portal vein thrombosis, positive lymph nodes, microscopic vascular invasion and tumour recurrence. Tumour size at the initial moment of diagnosis was not of predictive value. After surgery with curative intent disease-free interval at 1 and 5 years were 86 and 56%, respectively. Conclusion: In selected patients without cirrhosis, HCC can be treated successfully by surgical resection, independent of the tumour diameter, with a 5-year survival rate of 68%.

Prognostic factors after resection for hepatocellular carcinoma in noncirrhotic livers: univariate and multivariate analysis.

The aim of this study was to investigate the prognostic factors for hepatocellular carcinoma (HCC) in patients without cirrhosis who underwent hepatectomy. Between 1986 and 1998 a total of 197 men and 57 women with noncirrhotic HCC underwent hepatic resection in the Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. We determined their surgical mortality and the disease-free and overall cumulative survival rates. The surgical mortality was 4.7% and the 5-year disease-free survival rate 24.01%. By Cox regression analysis, serum alkaline phosphatase [relative risk (RR) 1.761; 95% confidence interval (CI) 1.037-2.985)], albumin (RR 2.179; CI 1.215-3.908), multiple tumor status (RR 2.288; CI 1.272-4.115), and blood urea nitrogen (RR 4.651; CI 1.116-19.38) were shown to be independent prognostic factors for the 5-year disease-free survival rates. The 5-year overall cumulative survival rate was 25.91%. By Cox regression analysis, serum albumin (RR 1.656, CI 1.005-2.730), blood transfusion (RR 2.075, CI 1.153-3.731), resection margin (RR 2.562, CI 1.436-4.572), and multiple tumors (RR 2.801, CI 1.727-4.545) were shown to be significant independent factors that influenced cumulative survival rates. Hence in patients with a noncirrhotic HCC who underwent hepatectomy the prognosis depended on preoperative hepatic function, the presence of multiple tumors, the need for blood transfusion, and the surgical resection margin.

Epstein–Barr virus and human hepatocellular carcinoma

Recent studies suggest that Epstein–Barr virus (EBV) may act as a helper virus for the development of hepatocellular carcinoma by promoting replication of the hepatitis C virus (HCV) in the infected liver. Detection of EBV DNA in a high percentage of HCV-positive human hepatocellular carcinomas (HCC) from Japanese patients has supported this concept. In order to determine whether EBV infection is associated with HCC, we examined paraffin-embedded tissues from 31 cases of non-cirrhotic livers with hepatocellular carcinoma for the presence of EBV, HCV and hepatitis B virus (HBV) infection. RNA prepared from tumor samples were used as a template for reverse transcription followed by double-nested PCR with primers for the 5′ untranslated region (NT) of HCV. DNA extracts of tumor samples were tested by single polymerase chain reaction for the detection of EBV and HBV (X- and/or S-gene) DNA sequences. To control for nucleic acid integrity, all tumor samples were amplified for human β-globin DNA by polymerase chain reaction and subjected to Southern blot hybridization. None of the cases was found to be positive for EBV. Ten HCC cases (32%) tested positive for HCV and 12 HCC cases (38%) tested positive for HBV. Six of the surveyed patients had nucleic acids of both HCV and HBV in their tumor tissue. All HCC tumor samples were positive for β-globin. Our study shows that HCV and HBV infections, but not EBV infection, are associated with hepatocarcinogenesis in non-cirrhotic livers. Other unknown risk factors seem to be in effect in the development of hepatocellular carcinoma in non-cirrhotic livers.

Hepatocellular carcinoma in noncirrhotic liver: CT, clinical, and pathologic findings in 39 U.S. residents.

To review clinical, pathologic, and computed tomographic (CT) findings in patients with hepatocellular carcinoma (HCC) in noncirrhotic liver. Clinical, pathologic, and imaging findings were retrospectively evaluated in 39 patients with HCC in noncirrhotic liver. Helical multiphasic CT scans obtained with 125 mL of contrast medium at a rate of 4 or 5 mL/sec were reviewed for morphologic features such as tumor size, margins, and hemorrhage and degree of enhancement. All patients (25 men, 14 women; mean age, 61 years) were U.S. residents; none had an Asian surname. Twenty-four patients (62%) had no identifiable risk factors; 34 (87%) were symptomatic. HCC was proved and cirrhosis excluded with biopsy in all cases. HCC was moderately (n = 32) or well (n = 6) differentiated in 97% of cases and poorly differentiated in one. Serum alpha-fetoprotein level was elevated in 26 patients. Large tumors (mean diameter, 12.4 cm) were depicted at CT in all cases. Thirty-two patients had a solitary or dominant mass. At CT, tumor margins were well defined in 21 patients, with a lobulated surface in 33. Calcifications were depicted in 11, hemorrhage in 10, fat in four, dilated intrahepatic bile ducts in 17, and abdominal lymphadenopathy in eight. In 38 patients, tumors were heterogeneous with areas of necrosis. HCC was hypoattenuating on nonenhanced images in 34, heterogeneously hyperattenuating at arterial phase in 38, and hypoattenuating at portal phase in 35 patients. HCC developed in the absence of cirrhosis or known risk factors and typically appeared as a large symptomatic hepatic tumor with clinical, laboratory, and CT features that distinguish it from most other hepatic masses.