1/75. Fibrolamellar carcinoma of the liver.We report a resected case of fibrolamellar carcinoma (FLC) of the liver that occurred in a 21 year-old Japanese male with a normal liver. lymph node metastases around the common hepatic artery and the hepatic hilum were revealed by a post-operative histological examination. He was in good health 7 months after the surgery. This case demonstrates typical findings of FLC, radiologically and histologically. The details are described in this report. Moreover, after reviewing 12 Japanese cases, we emphasize the differential diagnosis of focal nodular hyperplasia (FNH) as the following: 1) Calcification is frequently seen in FLC. 2) The central scar of FLC is visualized as an area of low intensity on T2-weighted magnetic resonance imaging (MRI).- - - - - - - - - - ranking = 1keywords = hyperplasia (Clic here for more details about this article) |
2/75. Clinicopathological characteristics of surgically resected minute hepatocellular carcinomas.BACKGROUND/AIMS: The multistep development of overt hepatocellular carcinoma from very well-differentiated early hepatocellular carcinoma, and of early hepatocellular carcinoma from adenomatous hyperplasia has been strongly suggested. The clinicopathologic and immunohistochemical characteristics of solitary minute hepatocellular carcinomas smaller than 1 cm in size have yet to be clarified. METHODOLOGY: Fourteen minute hepatocellular carcinomas were divided into 2 groups consisting of: 1) hepatocellular carcinoma of hepatitis b surface antigen positive patients (B-HCC) (n = 5), and 2) hepatocellular carcinoma of hepatitis c virus antibody positive patients (C-HCC) (n = 9), then they were all analyzed histopathologically and clinicopathologically. Immunohistochemical studies were also performed using the antibodies against p53 protein. RESULTS: Six of the 14 minute hepatocellular carcinoma were demonstrated to be moderately or poorly differentiated tumors. Among the 8 well-differentiated minute hepatocellular carcinomas, 2 tumors already contained less differentiated components. B-HCC tended to be less differentiated than C-HCC (P < 0.05). Adenomatous hyperplasia was detected in only 2 cases of C-HCC. Small cell liver dysplasia was detected significantly more frequently in C-HCC than in B-HCC (P < 0.05). The prognosis of the 14 minute hepatocellular carcinomas varied considerably. Immunohistochemically, some tumor cells were positive for p53 in 3 cases. CONCLUSIONS: Our study suggests that 1) the multistep carcinogenesis through adenomatous hyperplasia may not be so frequent, 2) De novo carcinogenesis from not only well-differentiated hepatocellular carcinoma, but also from less differentiated hepatocellular carcinoma, especially B-HCC, may be present, 3) the carcinogenesis in the B-HCC cases may behave differently from that in C-HCC cases, and 4) minute hepatocellular carcinomas demonstrate varying prognoses after hepatectomy.- - - - - - - - - - ranking = 3keywords = hyperplasia (Clic here for more details about this article) |
3/75. Veno-occlusive disease, nodular regenerative hyperplasia and hepatocellular carcinoma after azathioprine treatment in a patient with ulcerative colitis.We report the case of a 66-year-old male with ulcerative colitis diagnosed in 1987, who had been treated with azathioprine (AZA) for the past two years (average dose about 1.6 mg/kg/day). In May 1999 he presented with painless jaundice, fatigue and recent weight loss. Cholestatic enzymes were elevated, alpha-fetoprotein was normal and hepatitis b/C serology negative. After diagnosis of veno-occlusive disease (VOD) and hepatocellular carcinoma (HCC) via biopsy, tumour resection was performed. The histology was typical for a well-differentiated HCC with trabecular and pseudoglandular structures. Neighbouring liver tissue was atrophic, with nodular regenerative hyperplasia (NRH), peliosis-like sinusoidal ectasias and intra-sinusoidal accumulation of blood, associated with peri-sinusoidal fibrosis. Although none of the well-established risk factors for HCC such as cirrhosis, hepatitis b/C, metabolic liver disease or toxins were present, this patient developed HCC. This and previous reports suggest that NRH and/or VOD associated with AZA represent a risk factor for HCC. AZA should therefore not only be stopped in patients with NRH/VOD but patients should also be screened for HCC.- - - - - - - - - - ranking = 5keywords = hyperplasia (Clic here for more details about this article) |
4/75. liver adenoma and focal nodular hyperplasia associated with oral contraceptives.We report the case of a woman, with a 15-year history of high-dosage oral contraceptive use, who came to our center for a gynecological screening. Elevated liver enzymes were detected in blood samples and an abdominal ultrasound showed a hypoechogenic nodular image of 8 cm in the right hepatic lobe of the liver. Routine examinations, including hepatitis b surface antigen, hepatitis c viral antibody and alpha-fetoprotein, were all negative. Imaging studies, including computerized tomography scan, magnetic resonance imaging, sulfur colloid gammagraphy and hepatic angiography, were performed and confirmed the presence of the lesion, detecting the characteristic central scar structure of focal nodular hyperplasia. Discontinuation of oral contraceptives and follow-up showed no change in lesion size so that a surgical approach was adopted in order to remove the hepatocellular carcinoma. Pathological findings confirmed focal nodular hyperplasia.- - - - - - - - - - ranking = 6keywords = hyperplasia (Clic here for more details about this article) |
5/75. Contrast-enhanced MRI of the liver with mangafodipir trisodium: imaging technique and results.Magnetic resonance (MR) contrast agents are now routinely used for detecting and characterizing focal liver lesions. liver specific, hepatobiliary, MRI contrast agent mangafodipir trisodium (Mn-DPDP) is taken up by the functioning hepatocytes and excreted by the biliary system. Contrast uptake leads to persistent elevation of T1-weighted signal of normal liver parenchyma within 10 minutes of injection. Most tumors of non-hepatocellular origin typically are hypointense relative to enhanced liver parenchyma on T1 weighted images and are more conspicuous than on unenhanced images. Whereas, tumors of hepatocellular origin such as focal nodular hyperplasia (FNH), adenoma, and well-differentiated hepatocellular carcinomas (HCC) have been shown to accumulate Mn-DPDP, providing characterization information to discriminate hepatocellular from non-hepatocellular tumors. The purpose of this pictorial essay is to illustrate the appearance of various liver tumors on mangafodipir enhanced liver MR imaging.- - - - - - - - - - ranking = 1keywords = hyperplasia (Clic here for more details about this article) |
6/75. Development of well-differentiated hepatocellular carcinoma in large adenomatous hyperplasia after long-term follow-up: a case report.This report describes a 63-year-old man with a large adenomatous hyperplasia that had been followed over 10 years without any apparent change of size or profile, but grew rapidly after completion of interferon therapy. This patient was a sustained responder, in whom serum alanine aminotransferase levels remained within the normal range and the serum hepatitis c virus-rna level was undetectable after completion of interferon therapy. However, the tumors, located in segments 5 and 8 of the liver, which had both been followed as adenomatous hyperplasia, grew rapidly two months after completion of interferon therapy; imaging modalities revealed that the former was a typical hepatocellular carcinoma and the latter a large adenomatous hyperplasia. The patient underwent right paramedian sectoriectomy of the liver. Histological examination showed that the tumor in segment 8 had mosaic proliferation of hepatocytes without fibrosis, indicating adenomatous hyperplasia, in which a small focus of well-differentiated hepatocellular carcinoma was present. This case suggests that even in sustained responders to interferon, administration of this drug cannot suppress malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma. One year after surgery, the patient is doing well without signs of recurrence.- - - - - - - - - - ranking = 9keywords = hyperplasia (Clic here for more details about this article) |
7/75. Severe cytological atypia (large cell change) in focal nodular hyperplasia with numerous mallory bodies. A benign (adaptive) change?focal nodular hyperplasia (FNH) is a benign hepatocellular lesion composed of hyperplastic appearing hepatocytes arranged in nodules separated by fibrous septa that usually form a central stellate scar. Rare lesions that show unusual cytological or architectural features were reported as variants of focal nodular hyperplasia. We present the morphological features of a case of FNH with severe cytological atypia (so-called large cell change) in a 73-year-old man. In addition to diffuse cytological atypia, Mallory hyaline bodies were found in almost all lesional cells. This rare variant of FNH should be differentiated from other neoplastic lesions, in particular from the fibrolamellar variant of hepatocellular carcinoma.- - - - - - - - - - ranking = 6keywords = hyperplasia (Clic here for more details about this article) |
8/75. Simultaneous presence of focal nodular hyperplasia and hepatocellular carcinoma: case report and review of the literature.focal nodular hyperplasia (FNH) is an infrequent benign tumor of the liver that is generally believed to have no potential for malignant transformation; the coexistence of FNH and hepatocellular carcinoma (HCC) has seldom been reported. Here we describe an exceptional case of simultaneous FNH and HCC in the same patient and discuss the clinical and therapeutic management of FNH on the basis of a review of the literature.- - - - - - - - - - ranking = 5keywords = hyperplasia (Clic here for more details about this article) |
9/75. focal nodular hyperplasia with concomitant hepatocellular carcinoma: a case report and clonal analysis.This report describes a hepatocellular carcinoma (HCC) with concomitant focal nodular hyperplasia (FNH) in a 56 year old Chinese man. There were two well circumscribed tumours measuring 3 x 2.5 x 2 cm and 2 x 1.5 x 1.5 cm. The larger mass was grey and soft with a small area of bleeding and necrosis and an intact capsule. The smaller mass was yellow and had no capsule. Clonal analysis was carried out to clarify the relation between the HCC and the adjacent FNH. The clonal analysis was based on the methylation pattern of the polymorphic X chromosome linked androgen receptor gene (HUMARA). In FNH, after HpaII digestion, the allelic bands showed two well defined peaks. The intensity of the two peaks in the dna from cirrhotic tissue did not differ significantly, consistent with a random pattern of x chromosome inactivation. However, in HCC, after HpaII digestion, the allelic bands differed significantly in intensity. Therefore, there was a typical polyclonal pattern of inactivation in FNH but the HCC was interpreted as being monoclonal.- - - - - - - - - - ranking = 5keywords = hyperplasia (Clic here for more details about this article) |
10/75. Fibrolamellar hepatocellular carcinoma arising in a background of focal nodular hyperplasia: a report of 2 cases.BACKGROUND: Fibrolamellar carcinoma, a rare variant of hepatocellular carcinoma, and focal nodular hyperplasia, a benign lesion, are rare hepatic lesions that are known to occur in young women with noncirrhotic livers. Some have suggested that fibrolamellar carcinoma might be the malignant counterpart of focal nodular hyperplasia. The coexistence of the 2 lesions is very rare. CASES: Two cases of fibrolamellar hepatocellular carcinoma arising in a background of focal nodular hyperplasia followed long-term oral contraception, and 1 of the 2 occurred during pregnancy. CONCLUSION: Distinguishing fibrolamellar carcinoma from focal nodular hyperplasia has important implications for treatment and prognosis. One should be aware of such conditions, especially in patients with a long history of oral contraception.- - - - - - - - - - ranking = 8keywords = hyperplasia (Clic here for more details about this article) |
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