Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 14, 2009; 15(18): 2296-2299
Published online May 14, 2009. doi: 10.3748/wjg.15.2296
Scirrhous hepatocellular carcinoma displaying atypical findings on imaging studies
Soo Ryang Kim, Susumu Imoto, Taisuke Nakajima, Kenji Ando, Keiji Mita, Katsumi Fukuda, Ryo Nishikawa, Yu-ichiro Koma, Toshiyuki Matsuoka, Masatoshi Kudo, Yoshitake Hayashi
Soo Ryang Kim, Susumu Imoto, Taisuke Nakajima, Kenji Ando, Keiji Mita, Katsumi Fukuda, Ryo Nishikawa, Yu-ichiro Koma, Department of Gastroenterology, Kobe Asahi Hospital, Kobe, 653-0801, Japan
Toshiyuki Matsuoka, Department of Radiology, Osaka City University Medical School, Osaka, 545-8585, Japan
Masatoshi Kudo, Department of Gastroenterology and Hepatology, 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 (ICMRT), Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
Author contributions: Kim SR, Imoto S, Nakajima T, Ando K, Mita K, and Fukuda K designed and performed the research; Matsuoka T performed the radiology research; Kudo M analyzed the data; Hayashi Y performed the pathology research; Kim SR, Nishikawa R and Koma Y wrote the paper.
Correspondence to: Soo Ryang Kim, MD, Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bououji-cho, Nagata-ku, Kobe, 653-0801, Japan. info@kobe-asahi-hp.com
Telephone: +81-78-6125151
Fax: +81-78-6125152
Received: November 28, 2008
Revised: April 10, 2009
Accepted: April 17, 2009
Published online: May 14, 2009
Abstract

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.

Keywords: Scirrhous hepatocellular carcinoma; Contrast-enhanced computed tomography; Contrast-enhanced magnetic resonance imaging; Contrast-enhanced ultrasound; Computed tomography during hepatic arteriography; Computed tomography during arterial portography; Heterogeneous hypervascularity