Small hepatocellular carcinoma with minute satellite nodules

Background/Aims: To investigate the clinico-pathologic characteristics of small hepatocellular carcimona with minute satellite nodules. Methodology: We investigated the clinico-pathologic characteristics of 131 solitary small (≤2.0cm in diameter) hepatocellular carcinomas including 105 hepatocellular carcinomas without minute satellite nodules and 17 hepatocellular carcinomas with minute satellite nodules smiler than 5mm, and also discuss the clinical significance. Results: None of the clinical backgrounds of the patients and pathologic features of the main tumor, except for the average of preoperative serum α-fetoprotein, were significantly different between the two groups. Firstly, minute satellite nodules demonstrated the maximum diameter of all minute satellite nodules was 1.5-4.0mm, secondly, the moderately to poorly differentiated hepatocellular carcinomas had 4 or more minute satellite nodules within 1cm from the main tumor, while well differentiated hepatocellular carcinomas may have 1 or 2 minute satellite nodules 6cm or more away, and thirdly, 4 or more minute satellite nodules may present within 1cm in intrahepatic metastasis cases, while 1 or 2 minute satellite nodules may be present 6cm or more away from the main tumor in multi-centric occurrence cases. Conclusions: At least 13% of solitary small hepatocellular carcinomas had preoperatively undetectable minute satellite nodules. In case of moderately to poorly differentiated hepatocellular carcinomas, hepatic resection as well as percutaneous ethanol injection should be performed including the surrounding liver tissue at least 1.0cm from the main nodule. On the other hand, in well-differentiated hepatocellular carcinomas, which may indicate multicentric occurrence, closer observation and careful follow-up after therapy are recommended.