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Fibronodular hepatocellular carcinoma—a new variant of liver cancer: clinical, pathological and radiological correlation
  1. Jonathan Tefera1,2,
  2. Margarita Revzin1,
  3. Julius Chapiro1,
  4. Lynn Jeanette Savic1,2,
  5. David Mulligan3,
  6. Ramesh Batra3,
  7. Tamar Taddei4,
  8. Dhanpat Jain5,
  9. Xuchen Zhang5
  1. 1 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
  2. 2 Institute of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität, and Berlin Institute of Health, Berlin, Germany
  3. 3 Department of Transplantation and Immunology, Yale University School of Medicine, New Haven, CT, USA
  4. 4 Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
  5. 5 Department of Pathology, Yale School of Medicine, New Haven, CT, USA
  1. Correspondence to Xuchen Zhang, Department of Pathology, Yale University School of Medicine, New Haven, CT 06520-8023, USA; xuchen.zhang{at}


Aims To establish and define a new, not previously reported hepatocellular carcinoma (HCC) variant, termed fibronodular HCC (FN-HCC).

Methods We retrospectively reviewed 290 HCC cases and identified 29 FN-HCC and 24 scirrhous HCC (SCHCC). Clinical, pathological and radiological features of FN-HCC were reviewed and compared with 30 conventional HCCs (CV-HCC) and SC-HCC.

Results FN-HCCs were more likely to arise in non-advanced fibrotic livers with lower advanced Barcelona Clinic Liver Cancer (BCLC) stage, had lower rates of progression and longer time to progression and were more likely to be surgically resected compared with CV-HCCs and SC-HCCs. Imaging analysis of FN-HCCs demonstrated higher rates of non-peripheral washout and a new distinct pattern of enhancement which is characterised by the presence of multiple rounded nodules within a lesion embedded in fibrotic-appearing parenchyma.

Conclusions FN-HCC may represent a specific variant of HCC with distinct pathological, radiological and clinical features with potential ramifications for outcome.

  • liver neoplasms
  • classification
  • diagnostic techniques and procedures
  • liver

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  • Handling editor Runjan Chetty.

  • JT and MR contributed equally.

  • Correction notice This article has been corrected since it was published Online First. Abstract was missing and author middle name has been added.

  • Contributors All authors contributed to this project.

  • Funding This work was partially supported by the National Cancer Institute of the National Institutes of Health under award number R01CA206180-01A1(JD).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.