Difficult Diagnosis of a Patient with a Hypovascular Hepatic Tumor—A Case Report

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 81; no. 2; pp. 301 - 306
• Main Authors: KAMIDANI, Ryo, KIRIYAMA, Syunya, IKAWA, Aiko, SANO, Bun, ADACHI, Takahito, SHIROKO, Takashi, OKAMOTO, Kiyohisa
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2020
• Subjects: chemical phase shift; cytokeratin 7 stain; dysplastic nodule
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.81.301

A 64-year-old man was referred to our hospital for further investigation of a growing hepatic tumor of 1.5 cm in diameter that was located in segment 7. It was difficult to make a definite diagnosis of a dysplastic nodule or an early-stage hepatocellular carcinoma by abdominal sonography and enhanced computed tomography. A Gd-EOB-DTPA-enhanced MRI scan showed poor uptake of contrast agent in the hepatobiliary phase, but no signal change at a chemical phase shift. Nevertheless, hepatectomy of the posterior segment was performed because a malignant tumor could not be ruled out. The tumor was an unclear nodule without a coating and was histologically composed of a palisade structure with no atypical or high-density cells. A low-grade dysplastic nodule was diagnosed. Because a patient's liver with alcoholic change tends to have dysplastic nodules, it is very difficult to diagnose them. We think there is some possibility that a fat-containing evaluation such as a chemical phase shift is useful. It is also necessary to perform a comprehensive evaluation based on the diameter of the tumor, the clinical course, and multiple imaging modalities to make a diagnosis.