title: Lipid-rich clear-cell hepatocellular carcinoma arising in non-alcoholic steatohepatitis in a patient with diabetes mellitus.
abstract: A case of lipid-rich clear-cell hepatocellular carcinoma arising in non-alcoholic steatohepatitis is described in a patient with diabetes mellitus. The patient was a 67 year-old Japanese female with a history of tuberculosis, appendicitis, ischaemic heart disease, and non-insulin-dependent diabetes mellitus. The patient denied alcohol consumption. A liver mass was diagnosed as hepatocellular carcinoma of clear-cell type with early cirrhosis of the peri-tumoral liver tissue. Tumour cells had clear cytoplasm containing lipid droplets, and Mallory bodies. Surrounding non-tumoral liver tissue also showed lipid, and fibrosis in peri-portal areas with moderate bridging fibrosis. The features were consistent with clear-cell hepatocellular carcinoma arising in the fibrosis of non-alcoholic steatohepatitis. By electron microscopy, tumour cells had lipid droplets, glycogen, swollen mitochondria, rough endoplasmic reticulum, Mallory bodies, small bile canaliculi, desmosomes and gap junctions. Surrounding non-tumoral hepatocytes had a largely normal ultrastructure with prominent glycogen and lipid droplets. Clear-cell hepatocellular carcinoma within non-alcoholic steatohepatitis associated with diabetes mellitus is an extremely rare condition, and this report provides a detailed histopathological description with both immunohistochemical and ultrastructural data.
authors.affiliation: Department of Pathology, Saiseikai Central Hospital, Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Orikasa
authors.forename: R
authors.initials: R
authors.lastname: Ohyama
authors.forename: N
authors.initials: N
authors.lastname: Tsuka
authors.forename: B P
authors.initials: BP
authors.lastname: Eyden
authors.forename: K
authors.initials: K
authors.lastname: Yamazaki
mesh_terms: D000368:Aged; D001648:Bile Canaliculi / Q000648:ultrastructure; D014408:Biomarkers, Tumor; D006528:Carcinoma, Hepatocellular / Q000737:chemistry / Q000209:etiology* / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology; D005234:Fatty Liver / Q000150:complications* / Q000473:pathology; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007150:Immunohistochemistry; D007365:Intercellular Junctions / Q000648:ultrastructure; D008055:Lipids / Q000032:analysis*; D008113:Liver Neoplasms / Q000737:chemistry / Q000209:etiology* / Q000473:pathology; D008854:Microscopy, Electron; D015388:Organelles / Q000648:ultrastructure
chemical_list: D014408:Biomarkers, Tumor; D008055:Lipids