Post-transplantation hepatocellular carcinoma recurrence: Patterns and relation between vascularity and differentiation degree

Figure 1 Pre-contrast (A), hepatic arterial (B) and hepatic portal venous (C) phases multidetector CT scans demonstrate a hypovascular hepatocellular carcinoma (arrows), with no hypervascularization during the arterial phase (wash-in). Pathologically (HE stain, × 100) (D), it was classified as well-differentiated (Grade 1).

Figure 2 Representative multidetector CT images of different recurrence patterns based on the location at the moment of the first recurrence: (A) Extrahepatic recurrence presenting with a solitary pleural-based lung nodule; (B) Both intrahepatic and extrahepatic recurrence presenting with bone lesions and an intrahepatic lesion in segments IVb and V; (C and D) Intrahepatic recurrence presenting with a solitary hypervascular nodule in segment IV.

Figure 3 Multidetector CT scans demonstrating two hypervascular primary hepatocellular carcinoma nodules which were graded as moderately differentiated on histopathology (HE stain, magnification × 40 and × 200) (A); Multidetector CT scans of the same patient 2 years after LT demonstrating a hypovascular intrahepatic recurrent hepatocellular carcinoma, which was still graded as moderately differentiated on histopathology after resection (HE stain, magnification × 40 and × 200) (B).

Figure 4 Multidetector CT scans demonstrating a hypervascular area representing viable hepatocellular carcinoma next to a previously lipiodolized nodule, graded as moderately differentiated on histopathology (HE stain, magnification × 40 and × 200) (A); Multidetector CT scans of the same patients 1 year after LT demonstrating a hypervascular intrahepatic recurrent hepatocellular carcinoma, which was graded as poorly differentiated on histopathology after resection (HE stain, magnification × 40 and × 200) (B).