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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver?
Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Tadatoshi Takayama, Masahiko Sugitani
Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
Tadatoshi Takayama, Division of Gastroenterology and Hepatology, Department of Digestive Surgery, Nihon University School of Medicine, Tokyo 173-8610, Japan
Masahiko Sugitani, Department of Pathology, Nihon University School of Medicine, Tokyo 173-8610, Japan
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report exempt from the Institutional Review Board of Nihon University School of Medicine and Nihon University Itabashi Hospital.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All authors have no conflict-of-interest statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mariko Kumagawa, MD, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan. m_hayashida05@yahoo.co.jp
Telephone: +81-3-39728111 Fax: +81-3-39720015
Received: April 29, 2016
Peer-review started: May 3, 2016
First decision: June 17, 2016
Revised: July 12, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: September 18, 2016
Hepatocellular adenoma (HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography (CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A (SAA), focal positive for glutamine synthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.
Core tip: Hepatocellular adenoma (HCA) was classified into four pathological subtypes. And HCA usually arises in the absence of significant fibrosis. Recently, some reports about serum amyloid A (SAA) positive hepatocellular neoplasm were published. All tumors shared features with inflammatory HCA arising in alcoholic cirrhosis. We describe the contrast-enhanced ultrasonographic findings of SAA positive HCA.
