Hepatocellular Carcinoma Pathology

Hepatocellular carcinoma (liver cancer) is the most common malignant tumor in the liver in the adult. It occurs approximately 85% of the time in patients who have cirrhosis, the more  frequent causes of the associated cirrhosis including chronic hepatitis B and C; however, the tumor may also be seen in alcoholic cirrhosis and less common causes of cirrhosis such as idiopathic hemochromatosis. The tumor may consist of only one mass lesion, but often times may be multiple masses within the liver. There are a number of different changes seen on liver biopsy of these tumors, the most common of which is the formation of liver cell cords lined by endothelial cells (refer to image), the cords thicker than seen in normal non-tumor liver. When the tumor is well-differentiated, the neoplastic cells often show features that can be seen in normal hepatocytes such as fat and bile; however, in the poorly differentiated tumors, the cells may also be quite pleomorphic with giant cells and may be difficult to differentiate from certain metastatic tumors.

The image above shows the normal hepatic parenchyma, with a terminal hepatic venule (central venule), hepatic cords one to two cells thick, and adjacent sinusoids.

The image below shows a liver with hepatocellular carcinoma.