title: Contrast-enhanced ultrasonographic findings of serum amyloid A-positive hepatocellular neoplasm: Does hepatocellular adenoma arise in cirrhotic liver?
abstract: Hepatocellular adenoma (HCA) was recently classified into four pathological subtypes. There have been few studies describing the findings of contrast-enhanced ultrasonography (CEUS) of each type. Our case concerns a 78-year-old man who had undergone routine medical check-ups for hepatitis C for 11 years. Abdominal ultrasonography showed a 28 mm, hypo-echoic mass in the segment 4 of the liver. His integrating amount of drinking was 670 kg convert into ethanol. CEUS with Sonazoid demonstrated mild uniform hypo-enhancement with inflow of microbubbles from the periphery of the tumor in the arterial phase, and heterogeneously hypo-enhancement in the post vascular phase. Because the mass increased in size within 3 mo, a well differentiated hepatocellular carcinoma was suspected, and hepatic resection was performed. Microscopic findings showed homogeneous cell proliferation with low grade atypia, infiltration of inflammatory cells, ductular reactions, fatty deposit in part, and sinusoidal dilation. Immunohistochemistry revealed geographic positive for serum amyloid A (SAA), focal positive for glutamine synthetase, diffuse and strong positive for C-reactive protein, and positive for liver-type fatty acid binding protein. These pathological features corresponded to that of an inflammatory HCA. However, we could not make a clear diagnosis, because HCAs were defined as not to arise in cirrhotic liver. Finally, this tumor was diagnosed as a SAA positive hepatocellular neoplasm.
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Kumagawa
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsumoto
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Yukinobu
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Hirayama
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Miura
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakagawara
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Matsuoka
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Moriyama
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.affiliation: Mariko Kumagawa, Naoki Matsumoto, Yukinobu Watanabe, Midori Hirayama, Takao Miura, Hiroshi Nakagawara, Masahiro Ogawa, Shunichi Matsuoka, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sugitani
keywords: Alcoholic cirrhosis; Contrast-enhanced ultrasonography; Hepatocellular adenoma; Serum amyloid A; Serum amyloid A-positive hepatocellular neoplasms