A case of hemorrhage of hepatocellular carcinoma resembling a hepatic cyst arising from non-cirrhotic steatohepatitis
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CASE REPORT
A case of hemorrhage of hepatocellular carcinoma resembling a hepatic cyst arising from non‑cirrhotic steatohepatitis Sho Yatsuji1 · Yoshihito Kotera2 · Tomomi Kogiso1 · Satomi Saito1 · Akiko Omori2 · Takaomi Sagawa1 · Makiko Taniai1 · Kyoko Shimizu1 · Masakazu Yamamoto2 · Masayuki Nakano3 · Katsutoshi Tokushige1 Received: 30 July 2020 / Accepted: 16 September 2020 © Japanese Society of Gastroenterology 2020
Abstract A 70-year-old female was found to have multiple hepatic cysts at her annual checkup. In the posterior segment of the right lobe of the liver, an 81 × 67 mm circular cystic lesion was detected by contrast-enhanced computed tomography (CT). Magnetic resonance imaging (MRI) of the cyst revealed a solid component. The cyst had a capsule-like structure and nonuniform fluid accumulation suggested bleeding. Since the lesion was enlarged and malignancy could not be ruled out, it was surgically resected. Histopathologically, reticular fibers of the liver were seen in necrotic tissue and the lesion was diagnosed as a bleeding hepatocellular carcinoma (HCC). The non-cancerous liver tissue showed non-cirrhotic steatohepatitis. This was an unusual presentation of HCC. Keywords Cystic tumor · Bleeding hepatocellular carcinoma (HCC) · Non-cirrhotic liver disease · Non-alcoholic steatohepatitis (NASH)
Introduction Cystic liver lesions containing fluid-like accumulations can be benign or malignant [1], with the diagnoses including simple cyst and inflammatory, infectious, traumatic, and neoplastic lesions. For differential diagnosis, whether there are complex features in the cyst should be determined. Computed tomography (CT) and magnetic resonance imaging (MRI) findings can be used to differentiate cystic hepatic lesions. Cystic hepatocellular carcinoma (HCC) is usually related to internal necrosis and cystic degeneration in rapidly growing tumors. A solid component indicates hypervascularity, similar to an HCC [2]. In this case report, an HCC arising * Tomomi Kogiso [email protected] 1
Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, 8‑1 Kawada‑cho, Shinjuku‑ku, Tokyo 162‑8666, Japan
2
Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8‑1 Kawada‑cho, Shinjuku‑ku, Tokyo 162‑8666, Japan
3
Tokyo Central Pathology Laboratory, Hachioji, Tokyo 192‑0024, Japan
from non-cirrhotic, non-alcoholic steatohepatitis (NASH) bled spontaneously and formed a cyst-like lesion that was difficult to recognize as HCC. This study was conducted in accordance with the principles of the Declaration of Helsinki and the ethical guidelines of Tokyo Women’s Medical University Hospital (Tokyo, Japan).
Case report We treated a 70-year-old female patient who was found to have a 13-mm-diameter cystic lesion in the pancreatic tail and multiple hepatic cysts at her health checkup. She was referred to our hospital for investigation of both cystic lesions. She had a past history of cholecystectomy due to gallbladder stones, diab
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