Hepatocellular carcinoma differential diagnosis
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Differentiating Hepatocellular carcinoma from other Diseases |
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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]
- 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[3][4][5]10.2214/ajr.180.1.1800135[6]
- 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 | |||||||||||||
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| 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 | + | − | − | + | − | − | + | − | − | − | − |
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Other symptoms: |
| Chronic pancreatitis | Epigastric | − | − | ± | ± | − | + | + | − | − | − | − | N | CT scan
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| 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 |
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| Liver abscess | RUQ | + | + | + | + | − | ± | + | − | + | + | ± | Normal or hypoactive |
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| Cirrhosis | RUQ | − | − | − | + | − | − | + | + | + | − | − | N |
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US
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References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Kim TK, Jang HJ, Wilson SR (2006). "Benign liver masses: imaging with microbubble contrast agents". Ultrasound Q. 22 (1): 31–9. PMID 16641791.