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Komiyama S, Okazaki H, Nakao S, Nishigori S, Terada M, Hamanaka J, Miura Y, Oka H, Suzaki F, Tanaka K. Diffuse fatty metamorphosis of a large, well-differentiated hepatocellular carcinoma originating in the normal liver: a case report and literature review. Clin J Gastroenterol 2015; 8:345-50. [PMID: 26416601 DOI: 10.1007/s12328-015-0606-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/08/2015] [Indexed: 11/29/2022]
Abstract
Fatty changes are frequently observed in small, well-differentiated hepatocellular carcinomas (HCCs), but are rarely observed in large (over 30 mm in diameter) lesions. Here, we report a 76-year-old man who developed a large (58 mm in diameter), well-differentiated HCC with diffuse extensive fatty changes in the right lobe of the liver. He had no history of alcohol abuse, obesity, or hepatitis B or C infection, and no autoantibodies, but he did have type 2 diabetes. The serum alpha-fetoprotein level was within the normal range, and ultrasonography showed a round hyperechoic lesion. Dynamic contrast-enhanced computed tomography revealed a tumor with inhomogeneous low attenuation in the arterial, portal, and venous phases, mimicking an angiomyolipoma. The patient underwent central bisegmentectomy of the liver, and the histological diagnosis was well-differentiated HCC with diffuse extensive fatty changes. The surrounding non-cancerous area was normal. A review of the published literature found six published cases of large, well-differentiated HCC with extensive fatty changes. Unlike the patients in most previous reports, our patient did not have any underlying liver disease and had no history of alcohol abuse.
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Affiliation(s)
- Satoshi Komiyama
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
| | - Hiroshi Okazaki
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
| | - Satoshi Nakao
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Shuhei Nishigori
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Masahiro Terada
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Jun Hamanaka
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Yuki Miura
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Hiroyuki Oka
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Fumio Suzaki
- Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Katsuaki Tanaka
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
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Chou CT, Chou JM, Chang TA, Huang SF, Chen CB, Chen YL, Chen RC. Differentiation between dysplastic nodule and early-stage hepatocellular carcinoma: The utility of conventional MR imaging. World J Gastroenterol 2013; 19:7433-7439. [PMID: 24259975 PMCID: PMC3831226 DOI: 10.3748/wjg.v19.i42.7433] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 09/03/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the variety of ways early-stage hepatocellular carcinoma (HCC) can appear on magnetic resonance (MR) imaging by analyzing T1-weighted, T2-weighted, and gadolinium-enhanced dynamic studies.
METHODS: Seventy-three patients with well-differentiated HCC (wHCC) or dysplastic nodules were retrospectively identified from medical records, and new histological sections were prepared and reviewed. The tumor nodules were categorized into three groups: dysplastic nodule (DN), wHCC compatible with Edmondson-Steiner grade I HCC (w1-HCC), and wHCC compatible with Edmondson-Steiner grade II HCC (w2-HCC). The signal intensity on pre-contrast MR imaging and the enhancing pattern for each tumor were recorded and compared between the three tumor groups.
RESULTS: Among the 73 patients, 14 were diagnosed as having DN, 40 were diagnosed as having w1-HCC, and 19 were diagnosed as having w2-HCC. Hyperintensity measurements on T2-weighted axial images (T2WI) were statistically significant between DNs and wHCC (P = 0.006) and between DN and w1-HCC (P = 0.02). The other imaging features revealed no significant differences between DN and wHCC or between DN and w1-HCC. Hyperintensity on both T1W out-phase imaging (P = 0.007) and arterial enhancement on dynamic study (P = 0.005) showed statistically significant differences between w1-HCC and w2-HCC. The other imaging features revealed no significant differences between w1-HCC and w2-HCC.
CONCLUSION: In the follow-up for a cirrhotic nodule, increased signal intensity on T2WI may be a sign of malignant transformation. Furthermore, a noted loss of hyperintensity on T1WI and the detection of arterial enhancement might indicate further progression of the histological grade.
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Kim SH, Lee WJ, Lim HK, Park CK. SPIO-enhanced MRI findings of well-differentiated hepatocellular carcinomas: correlation with MDCT findings. Korean J Radiol 2009; 10:112-20. [PMID: 19270856 PMCID: PMC2651447 DOI: 10.3348/kjr.2009.10.2.112] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 11/28/2008] [Indexed: 01/23/2023] Open
Abstract
Objective This study was designed to assess superparamagnetic iron oxide (SPIO)-enhanced MRI findings of well-differentiated hepatocellular carcinomas (HCCs) correlated with their multidetector-row CT (MDCT) findings. Materials and Methods Seventy-two patients with 84 pathologically proven well-differentiated HCCs underwent triple-phase MDCT and SPIO-enhanced MRI at a magnetic field strength of 1.5 Tesla (n = 49) and 3.0 Tesla (n = 23). Two radiologists in consensus retrospectively reviewed the CT and MR images for attenuation value and the signal intensity of each tumor. The proportion of hyperintense HCCs as depicted on SPIO-enhanced T2- or T2*-weighted images were compared in terms of tumor size (< 1 cm and > 1 cm), five CT attenuation patterns based on arterial and equilibrium phases and magnetic field strength, by the use of univariate and multivariate analyses. Results Seventy-eight (93%) and 71 (85%) HCCs were identified by CT and on SPIO-enhanced T2- and T2*-weighted images, respectively. For the CT attenuation pattern, one (14%) of seven isodense-isodense, four (67%) of six hypodense-hypodense, four (80%) of five isodense-hypodense, 14 (88%) of 16 hyperdense-isodense and 48 (96%) of 50 hyperdense-hypodense HCCs were hyperintense (Cochran-Armitage test for trend, p < 0.001). Based on the use of multivariate analysis, the CT attenuation pattern was the only factor that affected the proportion of hyperintense HCCs as depicted on SPIO-enhanced T2- or T2*-weighted images (p < 0.001). Tumor size or magnetic field strength was not a factor that affected the proportion of hyperintense HCCs based on the use of univariate and multivariate analysis (p > 0.05). Conclusion Most well-differentiated HCCs show hyperintensity on SPIO-enhanced MRI, although the lesions show various CT attenuation patterns. The CT attenuation pattern is the main factor that affects the proportion of hyperintense well-differentiated HCCs as depicted on SPIO-enhanced MRI.
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Affiliation(s)
- Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
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Kim SR, Ikawa H, Ando K, Mita K, Fuki S, Sakamoto M, Kanbara Y, Matsuoka T, Kudo M, Hayashi Y. Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis. World J Gastroenterol 2007; 13:1271-4. [PMID: 17451213 PMCID: PMC4147007 DOI: 10.3748/wjg.v13.i8.1271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato-cellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase-associated protein 2, a new molecular marker of well-differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis.
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Affiliation(s)
- Soo Ryang Kim
- Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bouoji-cho, Nagata-ku, Kobe 653-0801, Japan.
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