title: Diffuse fatty metamorphosis of a large, well-differentiated hepatocellular carcinoma originating in the normal liver: a case report and literature review.
abstract: Fatty changes are frequently observed in small, well-differentiated hepatocellular carcinomas (HCCs), but are rarely observed in large (over 30 mm in diameter) lesions. Here, we report a 76-year-old man who developed a large (58 mm in diameter), well-differentiated HCC with diffuse extensive fatty changes in the right lobe of the liver. He had no history of alcohol abuse, obesity, or hepatitis B or C infection, and no autoantibodies, but he did have type 2 diabetes. The serum alpha-fetoprotein level was within the normal range, and ultrasonography showed a round hyperechoic lesion. Dynamic contrast-enhanced computed tomography revealed a tumor with inhomogeneous low attenuation in the arterial, portal, and venous phases, mimicking an angiomyolipoma. The patient underwent central bisegmentectomy of the liver, and the histological diagnosis was well-differentiated HCC with diffuse extensive fatty changes. The surrounding non-cancerous area was normal. A review of the published literature found six published cases of large, well-differentiated HCC with extensive fatty changes. Unlike the patients in most previous reports, our patient did not have any underlying liver disease and had no history of alcohol abuse.
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan. sat.komiyama@gmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Komiyama
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan. okapi.hiroshi@nifty.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okazaki
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakao
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nishigori
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Terada
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hamanaka
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Miura
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.affiliation: Department of Gastroenterology and Hepatology, Yokohama Minami Kyousai Hospital, 1-2-1 Mutuura-higasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Suzaki
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D005234:Fatty Liver / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male
keywords: Angiomyolipoma; Fatty metamorphosis; Well-differentiated hepatocellular carcinoma