Liver and intrahepatic bile ducts - tumor
Hepatocellular carcinoma
Small hepatocellular carcinoma

Author: Deepali Jain, M.D. (see Authors page)

Revised: 27 November 2017, last major update February 2012

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Small hepatocellular carcinoma[TI] free full text[sb]

Cite this page: Jain, D. Small hepatocellular carcinoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/livertumorsmallHCC.html. Accessed December 17th, 2017.
Definition / general
  • Defined as tumor less than 2 cm
  • Detected by screening of patients with chronic liver disease
Clinical features
  • May have normal serum AFP
  • Good prognosis
  • Two types:
    1. Gross and histologic features similar to classic HCC (small HCC of distinct nodular type)
    2. "Early HCC," well differentiated with indistinct margins (vaguely nodular type)
  • Early HCC is distinguished from dysplastic nodule by stromal invasion, absence of ductular reaction and panel of HSP70, glypican 3 and glutamine synthetase (72% sensitive, 100% specific for early HCC if at least 2 markers are positive, Hepatology 2007;45:725); inclusion of clathrin heavy chain (CHC) improves diagnostic accuracy (Gut 2012;61:1481)
  • Radiologically, early HCC is hypovascular, isovascular or very rarely hypervascular
Gross description
  • Vaguely nodular type: either not identifiable or nodules that bulge from cut surface
  • Gray, white, green or yellow; no necrosis; may be within borderline nodule (nodule within nodule)
  • Usually distinct fibrous capsule or fibrous septa; may have indistinct borders
Microscopic (histologic) description
  • Usually well differentiated morphology with irregular thin trabeculae 2 - 3 cells thick
  • Nuclear density is 2x normal, mild but definite nuclear atypia (hyperchromasia, irregular nuclear borders)
  • Unpaired arteries present; no substantial paucity of reticulin fibers
  • Enlarging nodules have less differentiated foci centrally
  • 40% have fatty or clear cell change, often with Mallory bodies
  • May invade stroma or portal tract but vascular invasion and intrahepatic metastases are rare
Microscopic (histologic) images

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Associated with hepatitis C