Hepatocellular carcinoma insitu does this lesion exist? A histopathological study of ultrasonography guided needle biopsies of focal solid defects within cirrhotic livers

ABSTRACT

Guided needle biopsies were taken from solitary or multiple solid focal hepatic defects [FHDs], detected during imaging of cirrhotic livers by ultrasonography [US] in 216 patients. In 198 patients [91.7%] the biopsies revealed primary hepatic malignancies, predominantly conventional hepatocellular carcinoma [HCC]. In 3 cases [1.4%] the biopsied lesions were macroregenerative nodules with or without mild atypia [MRNs] and in the remaining 15 cases [6.9%] the biopsies revealed macroregenerative modules with diffuse cytological atypia including nuclear irregularities, increased nucleocytoplasmic [N/C] ratio and scattered nucleolar prominence accompanied by thickening of some liver cell plates but without concomitant histological structural changes of hepatic carcinomas. It was suspected that these atypical macroregenerative nodules [AMRNs] may correspond to in situ malignant changes and it was tentatively suggested the term "hepatocellular carcinoma in situ" [HCIS] for these lesions. Similar AMRNs were also detected in association with 6 of the cases readily diagnosed as HCC