Hepatocellular carcinoma differential diagnosis

Jump to navigation Jump to search

Hepatocellular carcinoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes of Hepatocellular carcinoma

Differentiating Hepatocellular carcinoma from other Diseases

Epidemiology & Demographics

Risk Factors

Screening

Natural History, Complications & Prognosis

Diagnosis

Diagnostic study of choice

History and symptoms

Physical Examination

Lab Tests

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hepatocellular carcinoma differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hepatocellular carcinoma differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hepatocellular carcinoma differential diagnosis

CDC on Hepatocellular carcinoma differential diagnosis

Hepatocellular carcinoma differential diagnosis in the news

Blogs on Hepatocellular carcinoma differential diagnosis

Directions to Hospitals Treating Hepatocellular carcinoma

Risk calculators and risk factors for Hepatocellular carcinoma differential diagnosis

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 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][10]

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

Other symptoms:

Cholangiocarcinoma RUQ + − + + − − + − − − + Normal
  • Predisposes to pancreatic cancer
Pancreatic carcinoma MidEpigastric − − + + + − + − − − + Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − − Normal
  • Open biopsy if diagnosis can not be established
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
Gallbladder cancer Midepigastric − − + + − + + − − − − Normal
Liver hemangioma Intermittent RUQ − − + + − − − − − − − Normal
  • Abnormal LFTs
Liver abscess RUQ + − + + − − + − − − − Normal
  • US
  • CT
Cirrhosis RUQ+Bloating + − + + − − + − − − − Normal US
  • Stigmata of liver disease
  • Cruveilhier- Baumgarten murmur
Inflammatory lesions RUQ ± − + + − − − − − − − Normal US
  • Nodular,shrunken or coarse liver
  • Stigmata of liver disease

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, 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.
  11. ↑ Lee, So Jung; Kim, So Yeon; Kim, Kyoung Won; Shin, Yong Moon; Kim, Hyoung Jung; Lee, Jong Seok; Kim, Sun A (2012). "Hepatic angiomyolipoma with minimal fat, mimicking hepatocellular carcinoma". Clinical and Molecular Hepatology. 18 (3): 330. doi:10.3350/cmh.2012.18.3.330. ISSN 2287-2728.
  12. ↑ Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI (2015). "Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging". Abdom Imaging. 40 (3): 531–41. doi:10.1007/s00261-014-0244-4. PMID 25231411.
  13. ↑ Jeon TY, Kim SH, Lim HK, Lee WJ (2010). "Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver". Eur J Radiol. 73 (3): 601–6. doi:10.1016/j.ejrad.2009.01.010. PMID 19200676.
  14. ↑ Kim, T K; Choi, B I; Han, J K; Jang, H J; Cho, S G; Han, M C (1997). "Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings". Radiology. 204 (2): 539–543. doi:10.1148/radiology.204.2.9240550. ISSN 0033-8419.
  15. ↑ Choi BI, Kim TK, Han JK (1998). "MRI of clonorchiasis and cholangiocarcinoma". J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
  16. ↑ Guo, Le-Hang; Xu, Hui-Xiong (2015). "Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline". BioMed Research International. 2015: 1–5. doi:10.1155/2015/349172. ISSN 2314-6133.
  17. ↑ Wilson, Stephanie R.; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N. (2007). "Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI". American Journal of Roentgenology. 189 (1): W7–W12. doi:10.2214/AJR.06.1060. ISSN 0361-803X.
  18. ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM (1993). "Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT". Radiology. 188 (1): 31–5. doi:10.1148/radiology.188.1.8511316. PMID 8511316.
  19. ↑ Hussain, Hero K.; Syed, Ibrahim; Nghiem, Hanh V.; Johnson, Timothy D.; Carlos, Ruth C.; Weadock, William J.; Francis, Isaac R. (2004). "T2-weighted MR Imaging in the Assessment of Cirrhotic Liver". Radiology. 230 (3): 637–644. doi:10.1148/radiol.2303020921. ISSN 0033-8419.
  20. ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR (1993). "Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging". Radiology. 189 (3): 871–4. doi:10.1148/radiology.189.3.8234718. PMID 8234718.
  21. ↑ Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K (2009). "Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT". AJR Am J Roentgenol. 192 (5): 1341–7. doi:10.2214/AJR.07.2782. PMID 19380559.
  22. ↑ Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN (2004). "Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis". Clin Imaging. 28 (2): 124–7. doi:10.1016/S0899-7071(03)00243-2. PMID 15050225.
  23. ↑ Ooi CG, Chan KL, Peh WC, Saing H, Ngan H (1999). "Confluent hepatic fibrosis in monozygotic twins". Pediatr Radiol. 29 (1): 53–5. doi:10.1007/s002470050534. PMID 9880618.
  24. ↑ Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM (2013). "Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis". Magn Reson Imaging. 31 (7): 1137–42. doi:10.1016/j.mri.2013.01.011. PMID 23688409.
  25. ↑ Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). "Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation". AJR Am J Roentgenol. 178 (4): 877–83. doi:10.2214/ajr.178.4.1780877. PMID 11906867.
  26. ↑ Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). "Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation". Radiographics. 22 (4): 847–62. doi:10.1148/radiographics.22.4.g02jl17847. PMID 12110714.
  27. ↑ Newerla, Caroline; Schaeffer, Fabienne; Terracciano, Luigi; Hohmann, Joachim (2012). "Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings". Case Reports in Radiology. 2012: 1–5. doi:10.1155/2012/685486. ISSN 2090-6862.
  28. ↑ Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W, Kobayashi S, Gabata T, Ikeda H, Sato Y, Nakanuma Y (2012). "Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images". Jpn J Radiol. 30 (6): 499–508. doi:10.1007/s11604-012-0085-4. PMID 22618456.
  29. ↑ Matsui, O; Kadoya, M; Takahashi, S; Yoshikawa, J; Gabata, T; Takashima, T; Kitagawa, K (1995). "Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage". American Journal of Roentgenology. 164 (5): 1137–1140. doi:10.2214/ajr.164.5.7717220. ISSN 0361-803X.
  30. ↑ Itai Y, Matsui O (1999). "'Nonportal' splanchnic venous supply to the liver: abnormal findings on CT, US and MRI". Eur Radiol. 9 (2): 237–43. doi:10.1007/s003300050661. PMID 10101644.
  31. [[#cite_ref-NicolauBr�2004_31-0|↑]] Nicolau, C.; Br�, C. (2004). "Focal liver lesions: evaluation with contrast-enhanced ultrasonography". Abdominal Imaging. 29 (3). doi:10.1007/s00261-003-0117-8. ISSN 0942-8925. replacement character in |last2= at position 3 (help)
  32. ↑ Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB (2006). "Fatty liver: imaging patterns and pitfalls". Radiographics. 26 (6): 1637–53. doi:10.1148/rg.266065004. PMID 17102041.
  33. ↑ Hamer OW, Aguirre DA, Casola G, Sirlin CB (2005). "Imaging features of perivascular fatty infiltration of the liver: initial observations". Radiology. 237 (1): 159–69. doi:10.1148/radiol.2371041580. PMID 16100085.
  34. ↑ Memeo, M.; Stabile Ianora, A. A.; Scardapane, A.; Buonamico, P.; Sabbà, C.; Angelelli, G. (2004). "Hepatic involvement in hereditary hemorrhagic telangiectasia:". Abdominal Imaging. 29 (2): 211–220. doi:10.1007/s00261-003-0101-3. ISSN 0942-8925.
  35. ↑ Siddiki H, Doherty MG, Fletcher JG, Stanson AW, Vrtiska TJ, Hough DM, Fidler JL, McCollough CH, Swanson KL (2008). "Abdominal findings in hereditary hemorrhagic telangiectasia: pictorial essay on 2D and 3D findings with isotropic multiphase CT". Radiographics. 28 (1): 171–84. doi:10.1148/rg.281075037. PMID 18203937.
  36. ↑ Oliver JH, Baron RL (1996). "Helical biphasic contrast-enhanced CT of the liver: technique, indications, interpretation, and pitfalls". Radiology. 201 (1): 1–14. doi:10.1148/radiology.201.1.8816509. PMID 8816509.
  37. ↑ Yu JS, Kim KW, Sung KB, Lee JT, Yoo HS (1997). "Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging". Radiology. 203 (3): 737–42. doi:10.1148/radiology.203.3.9169697. PMID 9169697.
  38. ↑ Wu, Jim S.; Saluja, Sanjay; Garcia-Tsao, Guadalupe; Chong, Alice; Henderson, Katherine J.; White, Robert I. (2006). "Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients". American Journal of Roentgenology. 187 (4): W399–W405. doi:10.2214/AJR.05.1068. ISSN 0361-803X.
  39. ↑ Itai, Y; Matsui, O (1997). "Blood flow and liver imaging". Radiology. 202 (2): 306–314. doi:10.1148/radiology.202.2.9015047. ISSN 0033-8419.
  40. ↑ 40.0 40.1 {{cite
  41. ↑ Mathieu D, Vasile N, Dibie C, Grenier P (1985). "Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation". Radiology. 154 (3): 743–8. doi:10.1148/radiology.154.3.3881794. PMID 3881794.
  42. ↑ Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559
  43. ↑ 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.
  44. ↑ 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.
  45. ↑ 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.
  46. ↑ 46.0 46.1 Kim TK, Jang HJ, Wilson SR (2006). "Benign liver masses: imaging with microbubble contrast agents". Ultrasound Q. 22 (1): 31–9. PMID 16641791.
  47. ↑ 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.
  48. ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty |title= (help)
  49. ↑ 49.0 49.1 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.
  50. ↑ 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.
  51. ↑ 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.
  52. ↑ 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.
  53. ↑ 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.
  54. ↑ Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W (2008). "Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions". J Ultrasound Med. 27 (4): 657–66. PMID 18359914.
  55. ↑ Kim, Kyoung Won; Choi, Byung Ihn; Park, Seong Ho; Kim, Ah Young; Koh, Young Hwan; Lee, Hyun Ju; Han, Joon Koo (2004). "Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience". Ultrasound in Medicine & Biology. 30 (6): 725–733. doi:10.1016/j.ultrasmedbio.2004.03.006. ISSN 0301-5629.
  56. ↑ Syed MA, Kim TK, Jang HJ (2007). "Portal and hepatic vein thrombosis in liver abscess: CT findings". Eur J Radiol. 61 (3): 513–9. doi:10.1016/j.ejrad.2006.11.022. PMID 17161932.
  57. ↑ Menias, Christine O.; Surabhi, Venkateswar R.; Prasad, Srinivasa R.; Wang, Hanlin L.; Narra, Vamsi R.; Chintapalli, Kedar N. (2008). "Mimics of Cholangiocarcinoma: Spectrum of Disease". RadioGraphics. 28 (4): 1115–1129. doi:10.1148/rg.284075148. ISSN 0271-5333.
  58. ↑ Gollapudi P, Chejfec G, Zarling EJ (1992). "Spontaneous regression of hepatic pseudotumor". Am. J. Gastroenterol. 87 (2): 214–7. PMID 1734701.
  59. ↑ Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH (1999). "Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation". Radiology. 211 (2): 373–9. doi:10.1148/radiology.211.2.r99ma36373. PMID 10228516.
  60. ↑ CHEDID, Marcio F.; KRUEL, Cleber R. P.; PINTO, Marcelo A.; GREZZANA-FILHO, Tomaz J. M.; LEIPNITZ, Ian; KRUEL, Cleber D. P.; SCAFFARO, Leandro A.; CHEDID, Aljamir D. (2017). "HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT". ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 30 (4): 272–278. doi:10.1590/0102-6720201700040011. ISSN 2317-6326.


Template:WikiDoc Sources ​

Retrieved from "https://www.wikidoc.org/index.php?title=Hepatocellular_carcinoma_differential_diagnosis&oldid=1437196"