A Case of Well-Differentiated Hepatocellular Carcinoma that was Difficult to Diagnose Preoperatively

Shinjiro Kobayashi, Satoshi Koizumi, Takayuki Asano, Taiji Watanabe, Jyo Sakurai, Takeshi Asakura, Yasushi Ariizumi*, Jyunnki Koike*, Hiroshi Nakano and Takehito Ootsubo

Division of Gastroenterological and Department of General Surgery and Department of Pathology*, St Marianna University School of Medicine

A 62-year-old man admitted for a hepatic tumor 4 cm in diameter at right hepatic segment 8 appearing as a hypoechoic lesion in ultrasonography. Computed tomography (CT) showed the tumor to include a markedly low-density slightly enhanced by contrast medium. Magnetic resonance imaging showed the tumor to be rich in fat. Based on suspected hepatocellular carcinoma (HCC) with partial dedifferentiation or angiomyolipoma, we conducted partial hepatectomy of segment 8. Macroscopically, the cut surface of the tumor was whitish-yellow, and the histopathological diagnosis was well-differentiated HCC with massive macrovesicular steatosis in tumor cells. Only ten cases of HCC have, to our knowledge been reported with markable fatty change and exceeding 3.0 cm in diameter. We attribute this unusual condition to circulatory disorders in the tumor.

Key words
well differentiated hepatocellular carcinoma, fatty change

Reprint requests
Shinjiro Kobayashi Division of Gastroenterological and General Surgery, St Marianna University School of Medicine
2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511 JAPAN

Accepted
July 23, 2008

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