## Diagnostic and Prognostic Features of HCC ### Pathological Characteristics **Key Point:** HCC in cirrhotic livers typically exhibits a **trabecular growth pattern** with loss of normal hepatic architecture. The tumor is supplied by **unpaired arteries** (anomalous vessels without corresponding portal venules), a hallmark feature distinguishing HCC from benign nodules. ### Prognostic Factors in HCC | Feature | Prognostic Significance | Clinical Relevance | |---------|------------------------|--------------------| | **Microvascular invasion (MVI)** | Poor prognosis | Independent predictor of early recurrence; affects treatment decisions | | **Capsular invasion** | **Unfavorable** prognostic indicator | Associated with aggressive behavior and worse survival | | **Gross vascular invasion** | Very poor prognosis | Contraindication to curative resection | | **Tumor differentiation** | Well-differentiated better than poorly-differentiated | Guides treatment intensity | **High-Yield:** Capsular invasion (breach of the fibrous capsule surrounding the tumor) is a **negative prognostic factor**, not favorable. It indicates more aggressive tumor behavior and is associated with higher recurrence rates and reduced survival. ### Diagnostic Criteria (AASLD/EASL) **Clinical Pearl:** In a cirrhotic patient, HCC can be diagnosed non-invasively if: - **Nodule >10 mm**: Requires arterial phase enhancement + washout on CT or MRI - **Nodule 10–20 mm**: Requires both imaging modalities showing the above pattern, OR one imaging modality + elevated AFP - **Nodule <10 mm**: Surveillance; biopsy if growth documented Biopsy is reserved for nodules that do not meet imaging criteria or when diagnosis remains uncertain. ### Why Option 1 is Correct Capsular invasion is an **unfavorable** (not favorable) prognostic indicator. It represents breach of the tumor capsule and is associated with aggressive behavior, higher recurrence rates, and worse overall survival. This statement reverses the true prognostic significance.
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