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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.
