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Figure 11


Fig. 6 —Diagram shows changes of intratumoral arterial blood supply. In well-differentiated hepatocellular carcinoma (HCC) and moderately differentiated HCC, arterial blood supply increases as histologic grade progresses. Consequently, arterial blood supply decreases in poorly differentiated HCC as tumor grade advances. HCCs belonging to group 3 and group 4 and showing intermediate Ki-67 labeling index (here, it was defined as < 10)—that is, those considered to be on left side of peak (group 3' and group 4')—mainly consisted of moderately differentiated HCCs. HCCs belonging to group 3 and group 4 and showing high Ki-67 labeling index (≥ 10)—that is, those considered to be on right side of peak (group 3 and group 4)—mainly consisted of poorly differentiated HCCs. (Strictly speaking, it seems to be incompatible to place poorly differentiated HCC showing group 3' or group 4' into a portion labeled as well-differentiated HCC or moderately differentiated HCC. However, such tumor is rare.) Moderately differentiated HCC on line c shows same degree of arterial blood flow as poorly differentiated HCC on line d, but proliferative activity of HCC on line d is higher than that of HCC on line c. (It is difficult to distinguish d from c solely by means of CT hepatic arteriography and CT during arterioportography.) Poorly differentiated HCC on line e shows hypovascular and very high proliferative activity. It is possible to point out poorly differentiated HCC on line e, and thus we can predict proliferative activity of this type of tumor.