Clinical Features And Therapies Of Hepatic Dysplastic Nodule

Objective: In this study we analysed and explored the clinical featuresand therapeutic strategies of hepatic dysplastic nodule (HDN) in aretrospective study of twenty nine cases in the recent5years in the FourthHospital of Hebei Medical University.Methods:29cases of HDN (10concurrent with focal HCC) werecollected from January2007to December2011in Department ofhepatobiliary surgery, Fourth Hospital of Hebei Medical University. Mostpatients (20/29) suffered no complaints; laboratory tests included hepaticfunction, α-fetoprotein(AFP), hepatitis markers; imaging examinationsinvolved computed tomography(CT), ultrasound detection(US), megneticresonance imaging (MRI). All patients were mainly treated by surgery,combined with other treatments including microwave ablation, transcatheterhepatic artery infusion chemoembolization (TACE surgery), hepatic artery orportal venous DDS pump implantation. In this study,we mainly analysed andexplored the clinical features and therapeutic strategies of hepatic dysplasticnodule (HDN) and those concurrent with HCC.Results:1．Most patients (19/29) were relatively concentrated between46and65years old. The average age of non-malignance was48.8±14.8years, whileaverage age of malignance63.0±6.8years. There was significant differencebetween the age distribution of the two groups (P<0.05).2．There were19cases of non-malignance (M/F=16:3) and10cases ofmalignance (all male, no female).3．6cases of with normal AFP (6/17) developed HCC, while4cases withmildly elevated AFP (4/6) developed HCC. There was no significantdifference between the2groups (P>0.05).4．The incidence of carcinogenesis was significantly higher in HBsAg- positive patients (10/22) than HBsAg-negative (0/7).5．The incidence of carcinogenesis in patients with cirrhosis (13/23) washigher than those without cirrhosis (0/6).6．On US,8non-malignant nodules showed hyperechoic, while4hypoechoic;1malignant nodules showed hyperechoic, while4hypoechoic.7．On CT,17non-malignant nodule showed:13were hypodense duringplain scanning,10slightly enhanced while5obviously enhanced during arteryphase, and15iso-dense during venous phase.7malignant nodules showedclose to the non-malignant during plain scanning and venous phase, while6showed obvious enhancement and1not obvious during artery phase.8．On MRI,7non-malignant nodules showed:4were hypointense,3hyperintense on T1WI, while1was hypointense,6hyperintense on T2WI;after enhancement, all showed hyperintense, while iso-intense during venousphase and delayed phase.1malignant showed hyperintense both on T1WI andT2WI, was enhanced during artery phase and iso-intense during venous anddelayed phase.9．In this study,4non-malignant cases developed cancerous lesions inother parts of the livers discovered by CT in the later one or two years, ofwhich three cases were HBsAg-positive, one HBsAg-negative, with AFPnormal or slightly arising. One case was performed a second surgery, whosepathological examination indicated: liver cell dysplasia with focalcarcinogenesis. The other three were treated with a series of TACE surgery,with AFP fluctuating in the range of10.44~61.37ng/ml. The four cases are stillalive by follow-up.Conclusions:1．In this study, the high-risking age segment for HDNs and thoseconcurrent with HCC is46-65years, and with age grows, the risk ofcarcinogenesis increases.2．Male is more vulnerable to HDN, and has higher risk of developmentof carcinogenesis than female.3．AFP is neither sensitive nor special in diagnosis of HDNs with or without focal carcinogenesis.4．HBsAg-positive and cirrhosis are high risk factors for carcinogenesisof HDN.5．On US, HDNs mainly show hyperechoic, while hypoecho may indicatea increase of carcinogenesis; on CT, HDNs mainly show hypodense duringplain scanning, slight enhancement during arterial phase, and iso-dense duringvenous phase; and obvious enhancement during arterial phase may indicatecarcinogenesis; on MRI HDNs show hyper/hypointensity on T1WI, mainlyhyperintensity on T2WI, enhanced intensity during arterial phase andiso-intensity during venous phase and delayed phase; and a change of signalintensity may indicate carcinogenesis.6．HDNs and those with focal HCC show high diversity on US, thus it isdifficult to make a precise diagnosis; while CT and MRI show advantage inpredicting lesion's characteristics. Obvious enhancement during artery phasemeans high suspect of malignancy; hyperintensity of HDNs on T2WI mayindicates a high grade atypia, yet not carcinogenesis.7．Considering its precancerous characteristics and difficulty inpreoperative diagnosis, it is strongly advised to offer surgical treatment forHDNs with high risk factors, while those unavailable for surgery are advisedto undergo microwave or radio frequency ablation, and close postoperativefollow-ups should be taken into routine. Those concurrent with cancerouslesions should be treated on principle of HCC.