Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis.
We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato-cellular carcinoma (HCC) in a 56-year-old man with alcohol-related liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase-associated protein 2, a new molecular marker of well-differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis.
Kim
Soo Ryang
SR
Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bouoji-cho, Nagata-ku, Kobe 653-0801, Japan. info@kobe-asahi-hp.com
Ikawa
Hirotsugu
H
Ando
Kenji
K
Mita
Keiji
K
Fuki
Shuichi
S
Sakamoto
Michiie
M
Kanbara
Yoshihiro
Y
Matsuoka
Toshiyuki
T
Kudo
Masatoshi
M
Hayashi
Yoshitake
Y
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology*; D002471:Cell Transformation, Neoplastic; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged