Case Report
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2007; 13(43): 5775-5778
Published online Nov 21, 2007. doi: 10.3748/wjg.v13.i43.5775
Well to moderately differentiated HCC manifesting hyperattenuation on both CT during arteriography and arterial portography
Soo Ryang Kim, Susumu Imoto, Hirotsugu Ikawa, Kenji Ando, Keiji Mita, Shuichi Fuki, Michiie Sakamoto, Yoshihiro Kanbara, Toshiyuki Matsuoka, Masatoshi Kudo, Yoshitake Hayashi
Soo Ryang Kim, Susumu Imoto, Hirotsugu Ikawa, Kenji Ando, Keiji Mita, Shuichi Fuki, Department of Gastroenterology, Kobe Asahi Hospital, Kobe 653-0801, Japan
Michiie Sakamoto, Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
Yoshihiro Kanbara, Department of Surgery, Hyogo Cancer Center, Akashi 673-0021, Japan
Toshiyuki Matsuoka, Department of Radiology, Osaka City University Medical School, Osaka 545-8586, Japan
Masatoshi Kudo, Department of Gastroenterology, Kinki University School of Medicine, Osaka-Sayama 589-8511, Japan
Yoshitake Hayashi, Division of Molecular Medicine & Medical Genetics, International Center for Medical Research and Treatment, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Soo Ryang Kim, MD, Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bououji-cho, Nagata-ku, Kobe 653-0801, Japan.
Telephone: +81-78-6125151 Fax: +81-78-6125152
Received: July 12, 2007
Revised: August 24, 2007
Accepted: October 22, 2007
Published online: November 21, 2007

We present a rare case of well- to moderately-differentiated hepatocellular carcinoma (HCC) in a 71-year-old woman with hepatitis C virus-related cirrhosis and unusual radiologic features. A 20-mm hypoechoic nodule disclosed by ultrasound in segment two showed hyperattenuation on both computed tomography hepatic arteriography and computed tomography during arterial portography. Contrast-enhanced ultrasound revealed hypervascularity in the early vascular phase and defect in the post-vascular phase, with the same pattern detected by the two imaging techniques. SPIO-MRI revealed a hyperintense nodule. These findings were compatible with those of moderately-differentiated HCC. An ultrasound-guided biopsy showed histological features of well- to moderately-differentiated HCC characterized by more than two-fold the cellularity of the non-tumorous area, fatty change, clear cell change and mild cell atypia with a thin to mid-trabecular pattern. Further studies may provide insights into the correlation between tumor neovascularity in multistep hepatocarcinogenesis and dual hemodynamics, including the artery and the portal vein.

Keywords: Hepatocarcinogenesis, CT hepatic arteriography, CT during arterial portography, Hyperattenuation, Dual hemodynamics, Well- to moderately-differentiated hepatocellular carcinoma