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Special Feature
January 1, 2007

Image of the Month—Diagnosis

Arch Surg. 2007;142(1):96. doi:10.1001/archsurg.142.1.96

Histopathological findings showed the mass to be a well-differentiated, pedunculated hepatocellular carcinoma (HCC) with regions of necrosis and cystic degeneration. On immunohistochemical analysis, the tumor stained positively for alpha fetoprotein. Excision was complete, with a clear margin of 11 mm within the pedicle.

Pedunculated HCC can be defined as carcinoma protruding from the liver with or without a pedicle and was first described by Roux in 1897.1It is a rare variant of HCC; more frequently occurring variants are classified as nodular, massive, and diffuse.2Pedunculated tumors do not differ significantly from HCCs in terms of patient demographics, viral infection, or associated liver disease.3It has been proposed to subclassify the macroscopic appearances of pedunculated HCC into pedunculated type with a pedicle (subtype I, as is this case) and pedunculated type without a pedicle and attached to the liver surface (subtype II).4

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