Liver cell adenoma or hepatocellular carcinoma?

Recently, LCAs with typical backgrounds of the patients are diagnosed by radiological findings without pathological findings due to the progress of diagnostic imaging techniques. A typical LCA shows low density or isodensity on plain computed tomography, presents a homogenous contrasting effect on arterial phase and does not show an apparent wash out on delayed phase. A typical LCA in magnetic resonance imaging shows almost the same signal intensity as the surrounding parenchyma on T1 and T2 and shows high intensity on fat suppression T2. However, LCA often presents difficulties in a differential diagnosis with well-differentiated HCC, especially without the typical backgrounds of the patients.

A research article to be published on March 14, 2009 in the World Journal of Gastroenterology reports an extremely rare case of LCA. The research team led by Prof. Shimosegawa from the Division of Gastroenterology, Tohoku University reported a case of LCA found in a 40-year-old woman without a typical history in which the sequential alteration of the radiological findings suggested well-differentiated HCC.

A liver tumor 35 mm in diameter was found incidentally in a woman, which showed a homogenous enhancement in the arterial phase and almost the same enhancement as the surrounding liver parenchyma in the delayed phase of CT. The tumor was found to contain fat on MRI. However, radiological findings altered, which caused to suspect that a well-differentiated HCC containing fat was becoming dedifferentiated. Partial hepatectomy was performed and the pathological findings showed the typical findings of LCA. Diagnosis of LCA only by radiological findings is difficult in patients without backgrounds such as a history of receiving contraceptives or glycogen-storage disease.

Reference: Kogure T, Ueno Y, Sekiguchi S, Ishida K, Igarashi T, Wakui Y, Iwasaki T, Shimosegawa T. Liver cell adenoma showing sequential alteration of radiological findings suggestive of well-differentiated hepatocellular carcinoma. World J Gastroenterol 2009; 15(10): 1267-1272 http://www.wjgnet.com/1007-9327/15/1267.asp

Correspondence to: Yoshiyuki Ueno, MD, PhD, Division of Gastroenterology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo, Aoba-ku, Sendai 980-8574, Japan. yueno@mail.tains.tohoku.ac.jp Telephone: +81-22-7177171 Fax: +81-22-7177177

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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