Well-differentiated Hepatocellular Carcinoma, 35 mm in Diameter with Remarkable Fatty Change, Mimicking an Angiomyolipoma on Diagnostic Images -A Case Report

Atsuyuki Maeda, Katsuhiko Uesaka, Kazuya Matsunaga, Hideyuki Kanemoto, Noriyoshi Furukawa*, Naoki Morimoto*, Etsuro Bando** and Shigeki Yamaguchi**

Division of Hepato-Bilio-Pancreatic Surgery, Division of Diagnostic Radiology* and Division of Digestive Surgery**, Shizuoka Cancer Center Hospital

A 67-year-old Japanese man with hepatitis-C infection was referred to our institute because of a heaptic tumor of 3.3- cm in diameter in the right antero-superior subsegment of the liver. Ultrasonography revealed a hyperechoic lesion with a central low echoic area. CT showed tumor of remarkably low density (-20 Hounsfield Unit) with irregular central enhancement effect by contrast medium. Magnetic resonance imaging also revealed the fat-rich character of the tumor. The tumor was suspected to be a hepatocelluar carcinoma (HCC) with partial dedifferentiation or an angiromyolipoma. The patient was diagnosed as having an HCC from the liver biopsy and underwent a partial hepatectomy. On the resected specimen, the tumor was whitish yellow, 3.5 cm in diameter, and consisted predominantly of well differentiated HCC with remarkable fatty change. A small part of the tumor was dedifferentiated to moderately differentiated HCC. Histologically, the portal area and biliary epithelium remained in the tumor suggesting the tissue-replacing character of the tumor spread. Only two cases of well differentiated HCC have been reported with remarkable fatty change, and more than 3.0 cm in diameter. We attribute this unusual condition to circulatory disorders in the tumor.

Key words
well differentiated hepatocellular carcinoma, fatty change, angiomyolipoma

Reprint requests
Atsuyuki Maeda Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital
1007 Shimo-Nagakubo, Sunto-Nagaizumi, 411-8777 JAPAN

Accepted
February 23, 2005

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