Scirrhous hepatocellular carcinoma displaying atypical findings on imaging studies

Figure 1 Contrast-enhanced CT. Heterogeneous, not diffuse, hypervascular nodule in the early phase (A) (arrow), and a low-density area in the late phase (B) (arrow).

Figure 2 Contrast-enhanced MRI. A heterogeneous hypervascular nodule in the early phase (A) (arrow), and washout in the late phase (B) (arrow).

Figure 3 Contrast-enhanced US. Heterogeneous hypervascularity in the early phase (A) (arrow), and defect in the Kupffer phase (B) (arrow).

Figure 4 Heterogeneous hyperattenuation at CTA (arrow).

Figure 5 US-guided biopsy. Moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis (HE stain) (A), (Mallory-Azan stain) (B). Positive for Hp1 (C) and α-SMA (D).