Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis

Figure 1 Histolo-gical features of liver biopsy (April 2001), alcohol-related liver cirrhosis, microno-dular liver cirrhosis with fatty change (HE × 100).

Figure 2 A: US imaging (April 2005). A 10 mm hypoechoic nodule in S7; B: contrast enhanced US (April 2005). Hypovascularity in the early phase; C: US imaging (May 2006). A 10 mm hyperechoic nodule in S7.

Figure 3 Histological features of US-guided liver biopsy of the liver. A: High grade dysplastic nodule (April 2005): increased cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight atypia (HE × 200); B: Non nodular lesion (HE × 200) (April 2005), well-differentiated HCC (May 2006): increased cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, moderate atypia, and pseudoglandular formation (arrow) (HE × 200); C: Non-nodular lesion (May 2006); D: Immunohistochemical finding (May 2006) (HE × 200), CAP2 positive HCC cells are observed (more than 30%); E: Immunohistochemical finding (May 2006) (HE × 200): Liver cirrhosis is negative for CAP2; CAP2 positive HCC cells are observed (more than 30%); F: Immunohistochemical finding (May 2006) (HE × 200): Liver cirrhosis is negative for CAP2.