Contrast-enhanced computed tomography and ultrasound-guided liver biopsy to diagnose dysplastic liver nodules in cirrhosis

Morphophenotypic changes in human multistep hepatocarcinogenesis with translational implications

“…A further understanding can be provided by a deep analysis of the early most critical phases of the sequence, namely dysplastic nodules and eHCC. A few studies have investigated the natural history of these lesions showing that HGDN are the most advanced HCC precursors [4] [5] and that eHCC can transform at a variable rate into small, pHCC [6]. Of importance is a recent report demonstrating that eHCC rarely shows microvascular invasion and intrahepatic metastasis, with marginal survival benefit after the surgical treatment [7].…”

Diagnosing Borderline Hepatic Nodules in Hepatocarcinogenesis: Imaging Performance

“…Seventeen of the 37 lesions (46%) were isoattenuating in all phases and therefore not detected at CT. Unlike series showing that borderline nodules were mainly isovascular or hypovascular [52,[54][55][56], a 2013 study by Iavarone et al [57] showed a higher rate of hypervascular dysplastic nodules during arterial portography (17/36 [47%]), including 9 of A nodule-in-nodule appearance, characterized by hypervascular foci of HCC developing within a hypoattenuating borderline nodule, can be seen at both CT and CT angiography. These nodules have been found to progress to classic HCC [58], and CT has been found superior to MRI in the detection of small (< 5 mm) hypervascular foci in borderline lesions [59].…”

Phenotypic and molecular changes in nodule‐in‐nodule hepatocellular carcinoma with pathogenetic implications

“…Human hepatocarcinogenesis is a morphophenotypically multistep process with documented premalignant (dysplastic nodules), early malignant [early hepatocellular carcinoma (eHCC)] and progressed [progressed hepatocellular carcinoma (pHCC)] neoplastic lesions. These dynamics have been substantiated by the careful study of resected and explanted livers, and by the surveillance and follow‐up of individual lesions in cirrhotic patients . Progressive telomere shortening and telomerase reactivation have been previously documented in dysplastic and malignant hepatocellular lesions, further supporting the multistep nature of hepatocellular carcinogenesis .…”