A Case Report of Hepatocellular Carcinoma Associated with Sarcoid Reaction in Regional Lymph Nodes

Soon-Myoung Kang, Akihiro Murata, Masatoshi Shibutani, Seika Tei, Shinobu Yamada, Mizuyuki Kanemura, Kazuhiro Takeuchi, Atsunori Nitta and Hajime Tanaka

Department of Surgery, Seichokai Fuchu Hospital

We report an extremely rare case of hepatocellular carcinoma accompanied by sarcoid reaction in regional lymph nodes. A 67-year-old man with chronic hepatitis C admitted for back pain had serum α-fetoprotein elevated to 60 ng/ml. Abdominal ultrasonography showed a hyperechoic tumor about 4 cm in diameter in segment 5 of the liver. Dynamic bolus computed tomography (CT) showed peripheral enhancement of the tumor, accompanied by enlarged lymph nodes around the common hepatic artery and the inferior vena cava. Hepatic arteriography showed tumor staining, and CT during arterioportography showed a perfusion defect, yielding a diagnosis of hepatocellular carcinoma. Transcatheter arterial embolization (TAE) of the right hepatic artery was conducted, followed by microwave coagulation therapy to the liver tumor with lymph node dissection under laparotomy. Microscopically, biopsy specimens of the liver tumor showed poorly differentiated hepatocellular carcinoma, and dissected lymph nodes involved tumor metastasis including marked epithelioid granulomas.

Key words
hepatocellular carcinoma, sarcoid reaction, epithelioid granuloma

Reprint requests
Soon-Myoung Kang Department of Surgery, Seichokai Fuchu Hospital
1-10-17 Hiko-cho, Izumi, 594-0076 JAPAN

Accepted
June 28, 2006

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