Ahn Jem Ma, Paik Yong-Han, Lee Jun Hee, Cho Ju Yeon, Sohn Won, Gwak Geum-Youn, Choi Moon Seok, Lee Joon Hyeok, Koh Kwang Cheol, Paik Seung Woon, Yoo Byung Chul
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2015 Dec;21(4):393-7. doi: 10.3350/cmh.2015.21.4.393. Epub 2015 Dec 24.
A 51-year-old male patient with chronic hepatitis B was referred to our hospital due to a 1-cm liver nodule on ultrasonography. Alpha-fetoprotein (AFP) was slightly elevated. The nodule showed prolonged enhancement on dynamic liver magnetic resonance imaging and appeared as a hyperintensity on both diffusion-weighted and T2-weighted imaging. The nodule was followed up because it was small and typical findings of hepatocellular carcinoma (HCC) were not observed in the dynamic imaging investigations. However, liver contrast-enhanced ultrasonography performed 1 month later showed enhancement during the arterial phase and definite washout during the delayed phase. Also, AFP had increased to over 200 ng/mL even though AST and ALT were decreased after administering an antiviral agent. He was presumptively diagnosed as HCC and underwent liver segmentectomy. Microscopy findings of the specimen indicated bile duct adenoma. After resection, the follow-up AFP had decreased to within the normal range. This patient represents a case of bile duct adenoma with AFP elevation mimicking HCC on contrast-enhanced ultrasonography.
一名51岁的慢性乙型肝炎男性患者因超声检查发现肝脏有一个1厘米的结节而转诊至我院。甲胎蛋白（AFP）略有升高。该结节在肝脏动态磁共振成像上表现为强化延长，在扩散加权成像和T2加权成像上均呈高信号。由于结节较小且在动态成像检查中未观察到肝细胞癌（HCC）的典型表现，因此对其进行了随访。然而，1个月后进行的肝脏对比增强超声检查显示，动脉期有强化，延迟期有明确的廓清。此外，尽管在给予抗病毒药物后AST和ALT有所下降，但AFP已升至200 ng/mL以上。他被初步诊断为HCC并接受了肝段切除术。标本的显微镜检查结果显示为胆管腺瘤。切除术后，随访的AFP已降至正常范围内。该患者代表了一例胆管腺瘤伴AFP升高，在对比增强超声检查中酷似HCC的病例。
