Steatohepatitic hepatocellular carcinoma: Two cases report with literature review

Abstract

Steatohepatitic hepatocellular carcinoma (SH-HCC) is one of the most common hepatocellular carcinoma (HCC) subtypes, with a frequency of 5-20%. These tumor are well-differentiated and show distinct histologic features resembling steatohepatitis: Macrovesicular steatosis, inflammation, balloon cells, Mallory-Denk bodies and pericellular fibrosis. Because of their similar characteristics, distinguishing SH-HCC from background fatty liver can be a diagnostic challenge. The histology of SH-HCC has been described in resection specimens. Unfortunately, diagnostic criteria to aid in the evaluation of biopsy specimens have not been well established; therefore, the diagnosis of SH-HCC in biopsies remains challenging. On diagnostic imaging tests, SH-HCC may be difficult to distinguish from surrounding liver parenchyma in patients with severe hepatic steatosis or other fat-containing liver lesions such as angiomyolipoma or clear cell HCC. We report two cases of SH-HCC that we documented along with diagnostic difficulties.