title: Hepatocellular carcinoma with silent and cirrhotic non-alcoholic steatohepatitis, accompanying ectopic liver tissue attached to gallbladder.
abstract: A 70-year-old man had been obese since youth. He had been treated for hypertension and diabetes mellitus. An abdominal ultrasound showed a mass in the liver. He was admitted to St Marianna University School of Medicine Hospital for further evaluation. There was no history of alcohol use, and hepatitis viral markers and autoantibodies were all negative. Several imaging studies showed overt hepatocellular carcinoma (HCC). Transcatheter arterial embolization was performed, followed by surgical resection. Histopathological examination revealed moderately differentiated HCC. The non-tumor areas had pseudolobules in a diffuse pattern similar to alcoholic cirrhosis. The histological findings in the ectopic liver tissue attached to the gallbladder, which was also resected during surgery, were that there was no cirrhosis, but fine fibrosis with inflammatory cell infiltration of sinusoids. These findings were consistent with non-alcoholic steatohepatitis (NASH). There was probably a progression of similar findings that had developed into cirrhosis. These findings confirmed a diagnosis of HCC, cirrhosis, and underlying NASH in this patient. The present case is important for investigation of the development into cirrhosis and carcinogenesis of NASH. The present case demonstrates the importance of evaluating obese patients with fatty liver for underlying NASH and ongoing follow up for development of cirrhosis and HCC.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, St Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeda
authors.forename: Michihiro
authors.initials: M
authors.lastname: Suzuki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Minoru
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Okuse
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Moriya
authors.forename: Junki
authors.initials: J
authors.lastname: Koike
authors.forename: Shiro
authors.initials: S
authors.lastname: Maeyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yotsuyanagi
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis; D002828:Choristoma; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018450:Disease Progression; D005234:Fatty Liver / Q000150:complications* / Q000175:diagnosis; D005705:Gallbladder Diseases / Q000209:etiology*; D006801:Humans; D008099:Liver; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D009765:Obesity