title: Serum amyloid A and C-reactive protein positive nodule in alcoholic liver cirrhosis, hard to make definite diagnosis.
abstract: We describe a case of serum amyloid A (SAA) and C-reactive protein (CRP) positive nodule detected by immunohistochemical analysis in a 37-year-old woman with alcohol-related cirrhosis. Imaging studies at first admission pointed to hepatocellular carcinoma (HCC), a dysplastic nodule, an inflammatory pseudotumor or focal nodular hyperplasia (FNH). Ultrasonography-guided biopsy in Segment 2 showed minimal atypical changes, except for a slight increase in cell density and micronodular cirrhosis in the non-nodular portion. gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging carried out after a year and a half revealed hypervascularity in the arterial phase and isointensity in the hepatobiliary phase. Three years thereafter, however, the imaging displayed a change from isointensity to a defect in the hepatobiliary phase, and the nodule demonstrated minimal histological atypia. Immunohistochemical staining of the nodule was positive for SAA, CRP, liver fatty acid-binding protein and glutamine synthetase, but negative for β-catenin, heat shock protein 70 and Glypican 3. Organic anion transporter (OATP)8 staining was weaker in the nodule than in the non-nodular portion of the alcohol-related micronodular cirrhosis. The nodule was diagnosed as an SAA and CRP positive nodule, and HCC was ruled out. Despite the change from isointensity to a defect in the hepatobiliary phase, no evidence of HCC was found in the biopsy specimen. The change may be explained more by the weak OATP8 staining compared with that of alcohol-related liver cirrhosis than by malignant transformation into HCC.
authors.affiliation: Department of Gastroenterology, Kobe Asahi Hospital, Kobe, Japan.
authors.forename: Soo Ryang
authors.initials: SR
authors.lastname: Kim
authors.forename: Fukuo
authors.initials: F
authors.lastname: Kondo
authors.forename: Yumi
authors.initials: Y
authors.lastname: Otono
authors.forename: Susumu
authors.initials: S
authors.lastname: Imoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.forename: Makoto
authors.initials: M
authors.lastname: Hirakawa
authors.forename: Katsumi
authors.initials: K
authors.lastname: Fukuda
authors.forename: Madoka
authors.initials: M
authors.lastname: Sasaki
authors.forename: Soo Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Komaki
authors.forename: Shinobu
authors.initials: S
authors.lastname: Tsuchida
authors.forename: Sawako
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
keywords: alcohol-related liver cirrhosis; defect in the hepatobiliary phase; focal nodular hyperplasia; gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging; hepatocellular carcinoma; inflammatory hepatocellular adenoma