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To the Editor: Diffuse hepatocellular carcinoma (D‐HCC), also known as cirrhosis‐like HCC, is a rare and peculiar type of HCC.[1] The World Health Organization (WHO) defines D‐HCC as follows: small tumor nodules distributed diffusely all over the liver presents like cirrhotic‐associated regenerative nodules.[2] Surgical resection, radiotherapy, and medication cannot bring good results for D‐HCC, and the prognosis of D‐HCC is poor. Besides, differentiating multicentric occurrence (MO) from intrahepatic metastasis (IM), multiomics profiling could provide essential information to evaluate the aggressiveness of existing lesions and apply personalized therapies as well as postsurgical treatment.[3] D‐HCC occurs as an occult disease, providing few specific clinical manifestations, it resembles cirrhotic nodules on imaging, resulting in frequent misdiagnosis. Given the difficulty of obtaining tissues from the entire liver, recent research has focused on imaging studies.[2] The clonal origin pattern not only revealed the foundation of the tumor but is also closely associated with prognosis.[4] Therefore, this study aimed to determine the clonal origin pattern of D‐HCC tumors and draw the conclusion concerning their clinical, pathological, imaging, and prognostic features. Jakate et al.[1] studied D‐HCC livers obtained after transplantation. They summarized the pathological features of the disease and put forward a hypothesis for the clonal origin of the tumor; however, this hypothesis was yet to be proved.

Clinical Features and Clonal Origin of Diffuse Hepatocellular Carcinoma