Abstract: Objective To analyze the liver imaging and clinicopathological features of bimorphic hepatocellular carcinoma (B-HCC). Methods 111 patients with HCC admitted to the hospital of Lianyungang City between May 2017 and December 2024 were divided into a B-HCC group and other HCC groups. The general data, imaging data and pathological manifestations of the two groups of patients were compared. Results Of the 111 patients, 17 had B-HCC (B-HCC group) and 94 had other HCC (other HCC group). There were significant differences in age and AFP level between B-HCC and other HCC groups (P<0.05). There were statistically significant differences between B-HCC group and other HCC groups in peritumoral enhancement in arterial phase, peritumoral hypointensity in hepatobiliary phase and unsmooth tumor margin (P<0.05). Microscopically, the tumor cells of B-HCC are polygonal, showing thick beams, pseudoadenoids and masses, with rich blood sinus cavities, obvious nucleoli and frequent mitosis. In all of the seventeen cases (100%) the tumor cells expressed CK19, of which 10 cases (58.8%) expressed CK7 at the same time. AFP and Hepatocyte-1 were positive in 8 cases (47.0%) and 7 cases (41.2%) respectively. Ki-67 index is 14% ~ 70%. Compared with other HCC groups, the incidence of vascular infiltration and MVI in B-HCC group increased significantly (P<0.05). Conclusion Compared with other types of HCC, B-HCC patients has younger onset age, higher AFP level and complicated imaging manifestations. At the same time, the cell proliferation of B-HCC is active, and it is more prone to vascular infiltration and MVI.

Key words: Bimorphic hepatocellular carcinoma, Alpha fetoprotein, Ki-67 index