Histopathology
The cHCC-CC is a "mixed" type in 6/9 patients and "combined" type in 3/9 patients.
Serum markers
The AFP serum level was elevated in 5/9 but only one up to 200 ng/mL and the CA19-9 serum level was elevated in 2/3 patient.
These 2 patients have also an AFP serum level elavated.
Morphologic imaging findings
The cHCC-CC tumor presented as a single mass in all patients,
measuring from 1.5 to 10 cm on the axial plane (mean size 41 mm).
All the cHCC-CC were 6/9 localized in right liver and 3/9 in the left one.
The cHCC-CC margins were well-defined in 6/9 patients.
The tumor's structure (MRI/CT imaging) was heterogeneous in 6/9 and homogeneous in 3/9 cases.
All the cHCC-CC demonstrated on T1-w hypointensity and on T2-w hyperintensity.
(Fig. 1)
The cHCC-CC in CT pre-contrast phase was hypodenses in 8/9 patients and 1/9 patients isodense.
Dynamic imaging findings
On dynamic postcontrast imaging,
three patterns were observed in:
- 4/9 cases heterogeneous and central early enhancement at arterial phase followed by wash-out contrast on later phases and in one of these we observed a tumoral capsule in delayed phase contrast (HCC-like).
(Fig. 2, Fig. 3 and Fig. 4)
- 4/9 cases peripheric and thin enhancement at arterial phase followed by a centripetal progressive enhancement on later phases (CC-like).
(Fig. 5, Fig. 6,
Fig. 7 and Fig. 8)
- 1/9 of our cHCC-CC showed permanent hypodensity on pre- and post-contrast phases due to an important lesion's necrosis (hypovascular pattern).
(Fig. 9)
Necrosis was present in 4/9 patients,
in one of these was 90% of lesion.
Other imaging features
Cirrhosis signs were present in 7/9: liver morphological changes in 7/9 patients and a lobulated liver contours in 5/9 patients.
Hypertension signs: ascites was observed in 2/9 patients,
splenomegaly in 5/9 and porto-systemique shunts in 3/9.
Lymph node involvement was present in 2/9 patients and one of these was a metastasis.
Biliary dilatation directly related to the mass was present in 1/9 patient.
No vascular invasion or satellite tumors were detected.