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Hepatocellular [[carcinoma]] must be differentiated from other diseases that cause [[abdominal pain]], [[jaundice]], and [[weight loss]], such as [[hepatitis B]], [[hepatitis C]], liver cirrhosis, and [[pancreatitis]].
Hepatocellular [[carcinoma]] must be differentiated from other diseases that cause [[abdominal pain]], [[jaundice]], and [[weight loss]], such as [[hepatitis B]], [[hepatitis C]], liver cirrhosis, and [[pancreatitis]].
==Differentiating Hepatocellular Carcinoma from other Diseases==
==Differentiating Hepatocellular Carcinoma from other Diseases==
Hepatocellular carcinoma must be differentiated from the following diseases:<ref name="pmid26770920">{{cite journal |vauthors=Kim TK, Lee E, Jang HJ |title=Imaging findings of mimickers of hepatocellular carcinoma |journal=Clin Mol Hepatol |volume=21 |issue=4 |pages=326–43 |year=2015 |pmid=26770920 |pmc=4712159 |doi=10.3350/cmh.2015.21.4.326 |url=}}</ref><ref name="Ferrell2000">{{cite journal|last1=Ferrell|first1=Linda|title=Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems|journal=Modern Pathology|volume=13|issue=6|year=2000|pages=679–704|issn=0893-3952|doi=10.1038/modpathol.3880119}}</ref>
Hepatocellular carcinoma must be differentiated from the following diseases:<ref name="pmid26770920">{{cite journal |vauthors=Kim TK, Lee E, Jang HJ |title=Imaging findings of mimickers of hepatocellular carcinoma |journal=Clin Mol Hepatol |volume=21 |issue=4 |pages=326–43 |year=2015 |pmid=26770920 |pmc=4712159 |doi=10.3350/cmh.2015.21.4.326 |url=}}</ref><ref name="Ferrell2000">{{cite journal|last1=Ferrell|first1=Linda|title=Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems|journal=Modern Pathology|volume=13|issue=6|year=2000|pages=679–704|issn=0893-3952|doi=10.1038/modpathol.3880119}}</ref><ref name="KimLee2015">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref><ref name="DooLee2009">{{cite journal|last1=Doo|first1=Kyung Won|last2=Lee|first2=Chang Hee|last3=Choi|first3=Jae Woong|last4=Lee|first4=Jongmee|last5=Kim|first5=Kyeong Ah|last6=Park|first6=Cheol Min|title=“Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor|journal=American Journal of Roentgenology|volume=193|issue=6|year=2009|pages=W490–W496|issn=0361-803X|doi=10.2214/AJR.08.1732}}</ref><ref name="pmid17510541">{{cite journal |vauthors=Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO |title=MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA |journal=Magn Reson Med Sci |volume=6 |issue=1 |pages=43–52 |year=2007 |pmid=17510541 |doi= |url=}}</ref><ref name="ChengTsai1995">{{cite journal|last1=Cheng|first1=H C|last2=Tsai|first2=S H|last3=Chiang|first3=J H|last4=Chang|first4=C Y|title=Hyalinized liver hemangioma mimicking malignant tumor at MR imaging.|journal=American Journal of Roentgenology|volume=165|issue=4|year=1995|pages=1016–1017|issn=0361-803X|doi=10.2214/ajr.165.4.7676959}}</ref><ref name="pmid1370873">{{cite journal |vauthors=Haratake J, Horie A, Nagafuchi Y |title=Hyalinized hemangioma of the liver |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=234–6 |year=1992 |pmid=1370873 |doi= |url=}}</ref><ref name="TakayasuMoriyama1986">{{cite journal|last1=Takayasu|first1=K|last2=Moriyama|first2=N|last3=Shima|first3=Y|last4=Muramatsu|first4=Y|last5=Yamada|first5=T|last6=Makuuchi|first6=M|last7=Yamasaki|first7=S|last8=Hirohashi|first8=S|title=Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features|journal=American Journal of Roentgenology|volume=146|issue=6|year=1986|pages=1149–1153|issn=0361-803X|doi=10.2214/ajr.146.6.1149}}</ref><ref name="pmid11039718">{{cite journal |vauthors=Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K |title=Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case |journal=Surg. Today |volume=30 |issue=9 |pages=849–52 |year=2000 |pmid=11039718 |doi= |url=}}</ref>
*Angiomyolipoma
*Angiomyolipoma
*Adenoma
*Adenoma
Line 19: Line 19:
*Hereditary hemorrhagic telangiectasia
*Hereditary hemorrhagic telangiectasia
*Inflammatory pseudotumors
*Inflammatory pseudotumors
*[[Hemangioma|Liver hemangioma]]<ref name="KimLee2011">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Kyoung Ho|last3=Jang|first3=Hyun–Jung|last4=Haider|first4=Masoom A.|last5=Jacks|first5=Lindsay M.|last6=Menezes|first6=Ravi J.|last7=Park|first7=Seong Ho|last8=Yazdi|first8=Leyla|last9=Sherman|first9=Morris|last10=Khalili|first10=Korosh|title=Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma|journal=Radiology|volume=259|issue=3|year=2011|pages=730–738|issn=0033-8419|doi=10.1148/radiol.11101549}}</ref><ref name="pmid11833870">{{cite journal |vauthors=Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK |title=Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography |journal=J Ultrasound Med |volume=21 |issue=2 |pages=141–8 |year=2002 |pmid=11833870 |doi= |url=}}</ref><ref name="BranniganBurns2004">{{cite journal|last1=Brannigan|first1=Margot|last2=Burns|first2=Peter N.|last3=Wilson|first3=Stephanie R.|title=Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US|journal=RadioGraphics|volume=24|issue=4|year=2004|pages=921–935|issn=0271-5333|doi=10.1148/rg.244035158}}</ref><ref name="pmid16641791">{{cite journal |vauthors=Kim TK, Jang HJ, Wilson SR |title=Benign liver masses: imaging with microbubble contrast agents |journal=Ultrasound Q |volume=22 |issue=1 |pages=31–9 |year=2006 |pmid=16641791 |doi= |url=}}</ref><ref name="JangKim2003">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Kim|first2=Tae Kyoung|last3=Lim|first3=Hyo Keun|last4=Park|first4=Sang Jae|last5=Sim|first5=Jung Suk|last6=Kim|first6=Hyae Young|last7=Lee|first7=Joo-Hyuk|title=Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography|journal=American Journal of Roentgenology|volume=180|issue=1|year=2003|pages=135–141|issn=0361-803X|doi=10.2214/ajr.180.1.1800135}}</ref>
*[[Hemangioma|Liver hemangioma]]<ref name="KimLee2011">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Kyoung Ho|last3=Jang|first3=Hyun–Jung|last4=Haider|first4=Masoom A.|last5=Jacks|first5=Lindsay M.|last6=Menezes|first6=Ravi J.|last7=Park|first7=Seong Ho|last8=Yazdi|first8=Leyla|last9=Sherman|first9=Morris|last10=Khalili|first10=Korosh|title=Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma|journal=Radiology|volume=259|issue=3|year=2011|pages=730–738|issn=0033-8419|doi=10.1148/radiol.11101549}}</ref><ref name="pmid11833870">{{cite journal |vauthors=Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK |title=Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography |journal=J Ultrasound Med |volume=21 |issue=2 |pages=141–8 |year=2002 |pmid=11833870 |doi= |url=}}</ref><ref name="BranniganBurns2004">{{cite journal|last1=Brannigan|first1=Margot|last2=Burns|first2=Peter N.|last3=Wilson|first3=Stephanie R.|title=Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US|journal=RadioGraphics|volume=24|issue=4|year=2004|pages=921–935|issn=0271-5333|doi=10.1148/rg.244035158}}</ref><ref name="pmid16641791">{{cite journal |vauthors=Kim TK, Jang HJ, Wilson SR |title=Benign liver masses: imaging with microbubble contrast agents |journal=Ultrasound Q |volume=22 |issue=1 |pages=31–9 |year=2006 |pmid=16641791 |doi= |url=}}</ref><ref name="JangKim2003">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Kim|first2=Tae Kyoung|last3=Lim|first3=Hyo Keun|last4=Park|first4=Sang Jae|last5=Sim|first5=Jung Suk|last6=Kim|first6=Hyae Young|last7=Lee|first7=Joo-Hyuk|title=Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography|journal=American Journal of Roentgenology|volume=180|issue=1|year=2003|pages=135–141|issn=0361-803X|doi=10.2214/ajr.180.1.1800135}}</ref><ref>{{cite journal|doi=10.1102/1470-7330.2009.0015}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="BhayanaKim2010">{{cite journal|last1=Bhayana|first1=Deepak|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|last5=Wilson|first5=Stephanie R.|title=Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=977–983|issn=0361-803X|doi=10.2214/AJR.09.3375}}</ref><ref name="pmid21427331">{{cite journal |vauthors=Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H |title=Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium |journal=AJR Am J Roentgenol |volume=196 |issue=4 |pages=824–30 |year=2011 |pmid=21427331 |doi=10.2214/AJR.10.5113 |url=}}</ref><ref name="Heiken2007">{{cite journal|last1=Heiken|first1=Jay P.|title=Distinguishing benign from malignant liver tumours|journal=Cancer Imaging|volume=7|issue=Special Issue A|year=2007|pages=S1–S14|issn=1470-7330|doi=10.1102/1470-7330.2007.9084}}</ref><ref name="AlturkistanyJang2011">{{cite journal|last1=Alturkistany|first1=Samira|last2=Jang|first2=Hyun-Jung|last3=Yu|first3=Hojun|last4=Lee|first4=Kyoung Ho|last5=Kim|first5=Tae Kyoung|title=Fading hepatic hemangiomas on multiphasic CT|journal=Abdominal Radiology|volume=37|issue=5|year=2011|pages=775–780|issn=2366-004X|doi=10.1007/s00261-011-9826-6}}</ref>
*Hepatoblastoma in children
*Hepatoblastoma in children
*Inflammatory lesions
*Inflammatory lesions

Revision as of 13:42, 19 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Hepatocellular carcinoma must be differentiated from other diseases that cause abdominal pain, jaundice, and weight loss, such as hepatitis B, hepatitis C, liver cirrhosis, and pancreatitis.

Differentiating Hepatocellular Carcinoma from other Diseases

Hepatocellular carcinoma must be differentiated from the following diseases:[1][2][3][4][5][6][7][8][9]

  • Angiomyolipoma
  • Adenoma
  • Borderline (high-grade dysplastic) nodule
  • Cholangiocarcinoma
  • Confluent fibrosis
  • Focal nodular hyperplasia
  • Focal fat sparing and deposit on liver
  • Gallbladder cancer
  • Hereditary hemorrhagic telangiectasia
  • Inflammatory pseudotumors
  • Liver hemangioma[10][11][12][13][14][15][16][16][17][18][19][20]
  • Hepatoblastoma in children
  • Inflammatory lesions
  • Mesenchymal hamartoma in children
  • Multiacinar regenerative nodule
  • Macroregenerative nodule (low-grade dysplastic nodule)
  • Nontumorous arterioportal shunts
  • Pseudomass in chronic portal vein thrombosis
  • Pyogenic liver abscesses
  • Pancreatic cancer
  • Stomach cancer

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Hepatocellular carcinoma/Metastasis RUQ + − − + − − + − − − −
  • Normal
  • Hyperactive if obstruction present
  • US
  • CT
  • Liver biopsy

Other symptoms:

Chronic pancreatitis Epigastric − − ± ± − + + − − − − N
  • Increased amylase / lipase
  • Increased stool fat content
  • Pancreatic function test
 CT scan
  • Calcification
  • Pseudocyst
  • Dilation of main pancreatic duct
  • Predisposes to pancreatic cancer
Pancreatic carcinoma Epigastric − − + + − + + − − − − N

Skin manifestations may include:

Inflammatory bowel disease Diffuse ± − − ± − + + + − − − Normal or hyperactive

Extra intestinal findings:

Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments
Whipple's disease Diffuse ± − − ± − + + − ± − − N Endoscopy is used to confirm diagnosis.

Images used to find complications

Extra intestinal findings:
Viral hepatitis RUQ + − + + − Positive in Hep A and E + − Positive in fulminant hepatitis Positive in acute + N
  • Abnormal LFTs
  • Viral serology
  • US
  • Hep A and E have fecal-oral route of transmission
  • Hep B and C transmits via blood transfusion and sexual contact.
Liver abscess RUQ + + + + − ± + − + + ± Normal or hypoactive
  • US
  • CT
Cirrhosis RUQ − − − + − − + + + − − N US
  • Stigmata of liver disease
  • Cruveilhier- Baumgarten murmur

References

  1. ↑ Kim TK, Lee E, Jang HJ (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clin Mol Hepatol. 21 (4): 326–43. doi:10.3350/cmh.2015.21.4.326. PMC 4712159. PMID 26770920.
  2. ↑ Ferrell, Linda (2000). "Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems". Modern Pathology. 13 (6): 679–704. doi:10.1038/modpathol.3880119. ISSN 0893-3952.
  3. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  4. ↑ Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min (2009). ""Pseudo Washout" Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor". American Journal of Roentgenology. 193 (6): W490–W496. doi:10.2214/AJR.08.1732. ISSN 0361-803X.
  5. ↑ Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007). "MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA". Magn Reson Med Sci. 6 (1): 43–52. PMID 17510541.
  6. ↑ Cheng, H C; Tsai, S H; Chiang, J H; Chang, C Y (1995). "Hyalinized liver hemangioma mimicking malignant tumor at MR imaging". American Journal of Roentgenology. 165 (4): 1016–1017. doi:10.2214/ajr.165.4.7676959. ISSN 0361-803X.
  7. ↑ Haratake J, Horie A, Nagafuchi Y (1992). "Hyalinized hemangioma of the liver". Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
  8. ↑ Takayasu, K; Moriyama, N; Shima, Y; Muramatsu, Y; Yamada, T; Makuuchi, M; Yamasaki, S; Hirohashi, S (1986). "Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features". American Journal of Roentgenology. 146 (6): 1149–1153. doi:10.2214/ajr.146.6.1149. ISSN 0361-803X.
  9. ↑ Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K (2000). "Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case". Surg. Today. 30 (9): 849–52. PMID 11039718.
  10. ↑ Kim, Tae Kyoung; Lee, Kyoung Ho; Jang, Hyun–Jung; Haider, Masoom A.; Jacks, Lindsay M.; Menezes, Ravi J.; Park, Seong Ho; Yazdi, Leyla; Sherman, Morris; Khalili, Korosh (2011). "Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma". Radiology. 259 (3): 730–738. doi:10.1148/radiol.11101549. ISSN 0033-8419.
  11. ↑ Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK (2002). "Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography". J Ultrasound Med. 21 (2): 141–8. PMID 11833870.
  12. ↑ Brannigan, Margot; Burns, Peter N.; Wilson, Stephanie R. (2004). "Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US". RadioGraphics. 24 (4): 921–935. doi:10.1148/rg.244035158. ISSN 0271-5333.
  13. ↑ Kim TK, Jang HJ, Wilson SR (2006). "Benign liver masses: imaging with microbubble contrast agents". Ultrasound Q. 22 (1): 31–9. PMID 16641791.
  14. ↑ Jang, Hyun-Jung; Kim, Tae Kyoung; Lim, Hyo Keun; Park, Sang Jae; Sim, Jung Suk; Kim, Hyae Young; Lee, Joo-Hyuk (2003). "Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography". American Journal of Roentgenology. 180 (1): 135–141. doi:10.2214/ajr.180.1.1800135. ISSN 0361-803X.
  15. ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty |title= (help)
  16. ↑ 16.0 16.1 Jang, Hyun-Jung; Yu, Hojun; Kim, Tae Kyoung (2009). "Imaging of Focal Liver Lesions". Seminars in Roentgenology. 44 (4): 266–282. doi:10.1053/j.ro.2009.05.008. ISSN 0037-198X.
  17. ↑ Bhayana, Deepak; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N.; Wilson, Stephanie R. (2010). "Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout". American Journal of Roentgenology. 194 (4): 977–983. doi:10.2214/AJR.09.3375. ISSN 0361-803X.
  18. ↑ Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H (2011). "Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium". AJR Am J Roentgenol. 196 (4): 824–30. doi:10.2214/AJR.10.5113. PMID 21427331.
  19. ↑ Heiken, Jay P. (2007). "Distinguishing benign from malignant liver tumours". Cancer Imaging. 7 (Special Issue A): S1–S14. doi:10.1102/1470-7330.2007.9084. ISSN 1470-7330.
  20. ↑ Alturkistany, Samira; Jang, Hyun-Jung; Yu, Hojun; Lee, Kyoung Ho; Kim, Tae Kyoung (2011). "Fading hepatic hemangiomas on multiphasic CT". Abdominal Radiology. 37 (5): 775–780. doi:10.1007/s00261-011-9826-6. ISSN 2366-004X.


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