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A case of hepatocellular adenoma with pedunculated development and difficulty in diagnosis.

Authors :
Kawabe N
Higashiguchi T
Yasuoka H
Kawai T
Kamio K
Ochi T
Hayashi C
Shimura M
Furuta S
Arakawa S
Kondo Y
Asano Y
Nagata H
Ito M
Horiguchi A
Morise Z
Source :
Fujita medical journal [Fujita Med J] 2020; Vol. 6 (1), pp. 21-26. Date of Electronic Publication: 2019 Nov 02.
Publication Year :
2020

Abstract

Hepatocellular adenoma (HCA) is a benign hepatocyte-derived epithelial tumor. HCA is associated with oral contraceptive use among Caucasian populations. We report a case of hepatocellular adenoma with a pedunculated protuberance and high protein induced by vitamin K absence or antagonist-II (PIVKA-II) levels, which made diagnosis challenging. The patient was a 22-year-old woman. In a medical check-up, a high γ-GTP level was detected and a 115-mm solid mass was found in her lower abdomen via abdominal ultrasonography. A blood test showed a high PIVKA-II level. Abdominal CT showed a tumor in the lower abdomen. Contrast-enhanced CT showed a blood vessel thought to be the left hepatic artery connecting to the mass, and a blood vessel thought to be the left hepatic vein returning from the mass to the inferior vena cava. In EOB-MRI, uneven enhancement was observed after contrast imaging, but washout in the equilibrium phase was unclear. Parenchymal hepatocyte phases showed a pale, non-uniform, high signal. These findings indicated that the tumor was derived from the left lobe of the liver and was suggestive of HCC. Surgical resection was then performed. A pathological examination led to a diagnosis of HCA, corresponding to unclassified HCA. The WHO classification of tumors of the digestive system based on an immunohistological examination includes HNF1α-inactivated HCA, β-catenin-activated HCA, inflammatory HCA, and unclassified HCA. In summary, our patient had a large HCA with pedunculated protrusion into the extrahepatic pelvic cavity. This case was challenging to diagnose because of abnormally high PIVKA-II levels, and it was resected laparoscopically.

Details

Language :
English
ISSN :
2189-7255
Volume :
6
Issue :
1
Database :
MEDLINE
Journal :
Fujita medical journal
Publication Type :
Academic Journal
Accession number :
35111517
Full Text :
https://doi.org/10.20407/fmj.2019-005