title: Well-to moderately-differentiated HCC manifesting hyperattenuation on both CT during arteriography and arterial portography.
abstract: We present a rare case of well- to moderately-differentiated hepatocellular carcinoma (HCC) in a 71-year-old woman with hepatitis C virus-related cirrhosis and unusual radiologic features. A 20-mm hypoechoic nodule disclosed by ultrasound in segment two showed hyperattenuation on both computed tomography hepatic arteriography and computed tomography during arterial portography. Contrast-enhanced ultrasound revealed hypervascularity in the early vascular phase and defect in the post-vascular phase, with the same pattern detected by the two imaging techniques. SPIO-MRI revealed a hyperintense nodule. These findings were compatible with those of moderately-differentiated HCC. An ultrasound-guided biopsy showed histological features of well- to moderately-differentiated HCC characterized by more than two-fold the cellularity of the non-tumorous area, fatty change, clear cell change and mild cell atypia with a thin to mid-trabecular pattern. Further studies may provide insights into the correlation between tumor neovascularity in multistep hepatocarcinogenesis and dual hemodynamics, including the artery and the portal vein.
authors.affiliation: Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bououji-cho, Nagata-ku, Kobe 653-0801, Japan. info@kobe-asahi-hp.com
authors.forename: Soo Ryang
authors.initials: SR
authors.lastname: Kim
authors.forename: Susumu
authors.initials: S
authors.lastname: Imoto
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ikawa
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.forename: Keiji
authors.initials: K
authors.lastname: Mita
authors.forename: Shuichi
authors.initials: S
authors.lastname: Fuki
authors.forename: Michiie
authors.initials: M
authors.lastname: Sakamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kanbara
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Hayashi
mesh_terms: D000368:Aged; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D016174:Hepacivirus; D006499:Hepatic Artery / Q000000981:diagnostic imaging / Q000473:pathology; D006526:Hepatitis C / Q000473:pathology; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology; D008113:Liver Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D011172:Portography; D014057:Tomography, X-Ray Computed