Scirrhous hepatocellular carcinoma displaying atypical findings on imaging studies

• Published in: World journal of gastroenterology : WJG Vol. 15; no. 18; pp. 2296 - 2299
• Main Authors: Kim, Soo-Ryang, Imoto, Susumu, Nakajima, Taisuke, Ando, Kenji, Mita, Keiji, Fukuda, Katsumi, Nishikawa, Ryo, Koma, Yu, Matsuoka, Toshiyuki, Kudo, Masatoshi, Hayashi, Yoshitake
• Format: Journal Article
• Language: English
• Published: United States Department of Gastroenterology,Kobe Asahi Hospital,Kobe,653-0801,Japan%Department of Radiology,Osaka City University Medical School,Osaka,545-8585,Japan%Department of Gastroenterology and Hepatology,Kinki University School of Medicine,Osaka- Sayama,589-8511,Japan%Division of Molecular Medicine & Medical Genetics,International Center for Medical,Research and Treatment (ICMRT),Kobe University Graduate School of Medicine,Kobe,650-0017,Japan 14.05.2009; The WJG Press and Baishideng
• Subjects: Adenocarcinoma, Scirrhous - diagnosis; Adenocarcinoma, Scirrhous - pathology; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - pathology; Case Report; Humans; Liver Cirrhosis - pathology; Magnetic Resonance Imaging; Male; Middle Aged; Portography; Tomography, X-Ray Computed; Heterog; Contrastenhanced ultrasound; Computed tomography during hepatic arteriography; Contrast-enhanced computed tomography; Contrastenhanced magnetic resonance imaging; Scirrhous hepatocellular carcinoma; Computed tomography during arterial portography
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.15.2296

We describe a 15-mm scirrhous hepatocellular carcinoma (HCC) in a 60-year-old man with B-type cirrhosis. Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7. Contrast-enhanced US revealed heterogeneous, not diffuse, hypervascularity in the early phase and a defect in the Kupffer phase. Contrast-enhanced computed tomography (CT) revealed a heterogeneous hypervascular nodule in the early phase and a low-density area in the late phase. Magnetic resonance imaging (MRI) revealed iso- to hypointensity at T1 and high intensity at T2-weighted sequences. Contrast-enhanced MRI also revealed a heterogeneous hypervascular nodule in the early phase and washout in the late phase. Super-paramagnetic iron oxide-MRI revealed a hyperintense nodule. CT during hepatic arteriography and CT during arterial portography revealed heterogeneous hyperattenuation and a perfusion defect, respectively. Based on these imaging findings the nodule was diagnosed as a mixed well-differentiated and moderately-differentiated HCC. Histologically, the nodule was moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis. Immunohistochemically, the nodule was positive for heterochromatin protein 1 and alpha-smooth muscle actin, and negative for cytokeratin 19. From the above findings, the nodule was diagnosed as scirrhous HCC. Clinicians engaged in hepatology should exercise caution with suspected scirrhous HCC when imaging studies reveal atypical findings, as shown in our case on the basis of chronic liver disease.