Which malignant liver lesion can be single, multiple, or diffuse with solid nodules less than 5 cm, varying echogenicity with central scar, halo effect, hypervascularity, and vascular invasion?

Which malignant liver lesion can be single, multiple, or diffuse with solid nodules less than 5 cm, varying echogenicity with central scar, halo effect, hypervascularity, and vascular invasion?

• A. Hepatocellular Carcinoma
• B. Fibrolamellar carcinoma
• C. Hepatic Lipoma
• D. Hepatoblastoma

Answer: (A)

Hepatocellular carcinoma is defined by its vascular behavior and tendency to invade vessels. On ultrasound, HCC nodules can be solitary, multiple, or diffusely infiltrative, and small lesions under about 5 cm are common, especially in patients with cirrhosis. Their echogenicity is variable because the tumor composition may include fat, necrosis, fibrosis, or edema, giving hypoechoic, isoechoic, or hyperechoic appearances. A halo around the lesion can reflect a pseudocapsule. The hallmark is arterial hypervascularity due to neovascularization, often with washout in later phases, and a strong tendency to invade vascular channels such as the portal vein or hepatic veins. While a central scar might be seen in other tumors, the overall combination of variable echogenicity, a halo, hypervascularity, and evidence of vascular invasion in the right clinical setting most strongly points to hepatocellular carcinoma.

Hepatocellular carcinoma is defined by its vascular behavior and tendency to invade vessels. On ultrasound, HCC nodules can be solitary, multiple, or diffusely infiltrative, and small lesions under about 5 cm are common, especially in patients with cirrhosis. Their echogenicity is variable because the tumor composition may include fat, necrosis, fibrosis, or edema, giving hypoechoic, isoechoic, or hyperechoic appearances. A halo around the lesion can reflect a pseudocapsule. The hallmark is arterial hypervascularity due to neovascularization, often with washout in later phases, and a strong tendency to invade vascular channels such as the portal vein or hepatic veins. While a central scar might be seen in other tumors, the overall combination of variable echogenicity, a halo, hypervascularity, and evidence of vascular invasion in the right clinical setting most strongly points to hepatocellular carcinoma.