title: Hepatic adrenal rest tumor: Diagnostic pitfall and proposed algorithms to prevent misdiagnosis as lipid-rich hepatocellular carcinoma.
abstract: We present a case of adrenal rest tumor of the liver in which differential diagnosis from lipid rich-hepatocellular carcinoma (HCC) was challenging. The patient was a 50-year-old woman in whom a 3-cm tumorous mass was discovered in segment 7 of the liver during computed tomography evaluation of a uterine leiomyoma. The preoperative diagnosis was HCC, and subsegmental liver resection was performed. The tumor appeared as a well-demarcated golden yellow nodule consisting of clear or partially eosinophilic cells arranged in a trabecular pattern. The initial impression of this lesion was that of clear cell type or lipid-rich type HCC because it stained positive for Hep Par1, but negative for arginase-1 and positive for CD56 which is one of the neuroendocrine markers. The lesion also stained positive for SF-1 and 3β-HSD, both of which are markers of adrenocortical tissue. The final diagnosis was hepatic adrenal rest tumor. Hepatic adrenal rest tumor should be considered in the differential diagnosis of segment 7 tumor. A diagnostic algorithm that includes immunohistochemical staining for CD56 and arginase-1 is to rule out the possibility of lipid-rich HCC.
authors.affiliation: Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Takuma
authors.initials: T
authors.lastname: Tajiri
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Hiraiwa
authors.forename: Chie
authors.initials: C
authors.lastname: Inomoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kajiwara
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kojima
authors.forename: Kouske
authors.initials: K
authors.lastname: Tobita
authors.forename: Naoya
authors.initials: N
authors.lastname: Nakamura
mesh_terms: D000314:Adrenal Rest Tumor / Q000175:diagnosis*; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000175:diagnosis*; D008875:Middle Aged
chemical_list: D014408:Biomarkers, Tumor
keywords: CD56; adrenal rest tumor of the liver; arginase-1; hepatocellular carcinoma