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Sonographic Detection of Hepatocellular Carcinoma and Dysplastic Nodules in Cirrhosis: Correlation of Pretransplantation Sonography and Liver Explant Pathology in 200 Patients

Genevieve L. Bennett1, Glenn A. Krinsky1, Roxanne J. Abitbol1, Sue Y. Kim1, Neil D. Theise2 and Lewis W. Teperman3

1 Department of Abdominal Radiology, New York University Medical Center, 560 First Ave., New York, NY 10016.
2 Department of Pathology, New York University Medical Center, New York, NY 10016.
3 Department of Transplant Surgery, New York University Medical Center, New York, NY 10016.



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  		Fig. 1A. —41-year-old man with chronic hepatitis C. Hepatocellular carcinoma was identified on sonogram obtained before liver transplantation. Sonogram obtained 1 week before transplantation shows large ({approx} 6-cm) hypoechoic solid mass (cursors) in left lobe.

 


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  		Fig. 1B. —41-year-old man with chronic hepatitis C. Hepatocellular carcinoma was identified on sonogram obtained before liver transplantation. Photograph of transverse section (corresponding to A) of pathologic specimen from explanted liver shows neoplasm (arrows) in left lobe.

 


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  		Fig. 2A. —58-year-old man with chronic hepatitis C. Hepatocellular carcinoma was identified on sonogram obtained before liver transplantation. Sonogram obtained 1 month before transplantation shows 2-cm hypoechoic mass (cursors) in right lobe.

 


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  		Fig. 2B. —58-year-old man with chronic hepatitis C. Hepatocellular carcinoma was identified on sonogram obtained before liver transplantation. Photograph of transverse section (corresponding to A) of pathologic specimen from explanted liver shows neoplasm (arrows) in right lobe.

 


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  		Fig. 3A. —50-year-old man with chronic hepatitis C. Dysplastic nodule was identified on sonogram obtained before liver transplantation. Sonogram obtained 9 days before transplantation shows 2-cm hypoechoic nodule (solid arrow) in left lobe. Remainder of liver shows heterogeneous echotexture, although no other focal lesion was identified. Open arrow indicates left branch of portal vein.

 


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  		Fig. 3B. —50-year-old man with chronic hepatitis C. Dysplastic nodule was identified on sonogram obtained before liver transplantation. Photograph of transverse section (corresponding to A) of pathologic specimen from explanted liver shows mass (arrow) in left lobe histologically diagnosed as high-grade dysplastic nodule.

 


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  		Fig. 3C. —50-year-old man with chronic hepatitis C. Dysplastic nodule was identified on sonogram obtained before liver transplantation. Photograph of additional transverse section obtained at different location in pathologic specimen from explanted liver shows 5-cm hepatocellular carcinoma (arrows) in right lobe that was not visualized on sonography.

 


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  		Fig. 4A. —31-year-old woman with multifocal hepatocellular carcinoma that was not detected on sonography performed before liver transplantation. Sonogram obtained 3 days before transplantation shows diffusely altered echotexture of liver parenchyma. However, no discrete lesion was identified.

 


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  		Fig. 4B. —31-year-old woman with multifocal hepatocellular carcinoma that was not detected on sonography performed before liver transplantation. Photograph of transverse section (corresponding to A) of pathologic specimen from explanted liver shows diffuse multifocal hepatocellular carcinoma with innumerable small lesions (small arrows); largest lesion (1-cm diameter, large arrow) is visible in left lobe.

 

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