Outcomes of Small Nodular Lesions in Heavy Drinkers |
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Authors: | Michihiro Suzuki Shiro Maeyama Kouji Nishikawa Noriaki Okuse Kiyoe Hashizume Yukimitu Mamada Yutaro Kobayashi Chiaki Okuse Yasuhito Takahashi Taturo Osada Takeshi Hayashi Hiroshi Yotuyanagi Hiroshi Suzuki Seiichiro Ogata Toshiyuki Uchikoshi Shiro Iino |
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Affiliation: | Department of Internal Medicine, Division of Gastroenterology and Hepatology (M.S., K.N., N.O., K.H., Y.M., Y.K., C.O., Y.T., T.O., T.H., H.Y., H.S., S.I.), and the Department of Pathology (S.M., S.O., T.U.), St. Marianna University School of Medicine, 2–16–1 Sugao, Miyamae-ku, Kawasaki-shi, Kanagawa 216–8511, Japan. |
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Abstract: | Background Increased detection of nodular lesions in patients not yet definitively diagnosed with hepatocellular carcinoma (HCC) has occurred with the use of advanced imaging techniques. In heavy drinkers, decrease in the size of nodular lesions during on-going observation, and negation of diagnoses of HCC after surgical resection have been reported, suggesting the need for caution in diagnosis in such cases. Methods The subjects were eight heavy drinkers with small nodular lesions, 20 mm or less in diameter. All patients were male, with a mean age of 53 years. Five had single and three had multiple nodular lesions. Five of the eight patients were followed up for more than 4 years after an initial biopsy, while three patients were recent cases. Of the three recent cases, two were positive for antibody to hepatitis C virus (HCV) and two had hypervascular nodular lesion. Biopsies were performed percutaneously, under ultrasonography, for histological diagnosis of all cases, and the recent cases were also assessed using a variety of imaging techniques. Results On initial biopsy, no atypism (NO) was found in two patients, and borderline lesions (Border) were present in six patients. Of the five cases followed up long-term, only one of the two with NO progressed to HCC, and the three with Border showed disappearance, decrease, and no change, respectively, during the follow-up period. Of the three recent cases, no changes in size or morphology as revealed by imaging were observed following biopsy. Conclusions In heavy drinkers, no fixed relationship was observed between initial biopsy finding and clinical course, suggesting that indication for biopsy requires reassessment, refinement, and discussion. Furthermore, tumor staining may occur in hyperplastic nodules, which are histologically similar to early HCC by needle biopsy, and care needs to be exercised for diagnosis in heavy drinkers. |
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Keywords: | Small Nodular Lesion Heavy Drinker Borderline Lesion Hepatocellular Carcinoma |
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