Fig. 8.10 Pale bodies in hepatocellular carcinoma. A Haematoxylin and eosin. B Immunoreactivity for fibrinogen.

with suspected HCC metastases, a chest X-ray, bone scan, or other imaging modalities may be indicated.

Liver biopsy

The definitive diagnosis of HCC depends on the histological examination of the lesion, especially in AFP-negative patients. Ultrasound- or CT-guided percutaneous biopsy with a 22-gauge needle usually provides sufficient tissue for diagnosis with minimum risk of bleeding or seeding of tumour cells along the needle tract. However, in patients with significantly elevated AFP levels who are potentially eligible for HCC resection or liver transplantation, liver biopsy is not recommended to eliminate the residual risk of tumour cells spreading before surgery.


Macroscopic features of HCCs vary depending on the size of the tumour and the presence or absence of liver cirrhosis. In general, most HCCs associated with liver cirrhosis tend to present as an expansile tumour with a fibrous capsule and intratumoural septa, while those without cirrhosis tend to be massive and non-encapsulated. Varying degrees of infiltrative growth, tumour thrombi in the portal veins, and intrahepatic metastases, which are common in advanced tumours, modify the gross appearance. Occasionally, numerous minute tumour

Table 8.D1

Immunohistochemistry of HCC.

nodules are distributed throughout the liver and may be difficult to be distinguished from regenerative nodules in liver cirrhosis.

Hepatocellular carcinomas are occasionally pedunculated. Patients are usually females and the tumours are thought to arise in accessory lobes of the liver. Following surgical resection, the prognosis is excellent.

Table 8.D1

Immunohistochemistry of HCC.



Hepatocyte (Dako)

Positive (most useful in diagnosis)

Polyclonal carcinoembryonic antigen

Positive (canalicular pattern)

Alpha fetoprotein

Positive or negative


Positive or negative

Cytokeratins 8 and 18

Usually positive

Cytokeratins 7 and 19

Usually negative

Cytokeratin 20

Usually negative

Epithelial membrane antigen


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