Oji Kentaro, Urade Takeshi, Iwatani Yoshiteru, Tanaka Katsuhide, Hirano Hirotaka, Sanuki Tsuyoshi, Tomita Masaru, Yamamoto Yuki, Zen Yoh, Kuroda Daisuke
Department of Surgery and Digestive Surgery, Kita-Harima Medical Center, 926-250, Ichiba-cho, Ono, 675-1392, Japan.
IHU Strasbourg Institute of Image-Guided Surgery, 1, Place de l'Hôpital, 67091, Strasbourg, CEDEX, France.
Surg Case Rep. 2019 Aug 13;5(1):131. doi: 10.1186/s40792-019-0689-3.
Hepatocellular adenoma (HCA) is a rare liver tumor that has the potential for rupture and malignant transformation. Here, we report a case of multiple hepatocellular adenomas (HCAs) that were treated by surgical resection.
An 18-year-old man was admitted to our hospital with proteinuria. His height was 176.5 cm, weight was 126 kg, and body mass index was 40 kg/m. A liver tumor was incidentally found on abdominal ultrasonography. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed three hepatic tumors that were 68 mm, 16 mm, and 9 mm in segments 3/4, 8, and 1, respectively. A percutaneous needle biopsy of the largest tumor was performed, the diagnosis of unclassified type HCA was made, and laparoscopic partial liver resection was performed of all three. The postoperative course was uneventful, and the patient was discharged 12 days later. An immunohistochemical examination revealed positivity for serum amyloid A protein, no decrease in fatty acid-binding protein, and negativity for β-catenin, glutamine synthetase, and cytokeratin 7. Therefore, these tumors were diagnosed as inflammatory type HCAs.
We reported an extremely rare case of multiple resected HCAs in a young, obese Japanese man. Our findings suggest that HCA should be considered in the differential diagnosis of liver tumor in obese patients. Further studies that consider clinical and molecular risk factors are required to establish individualized treatment plans for HCA in obese patients.
肝细胞腺瘤（HCA）是一种罕见的肝脏肿瘤，有破裂和恶变的可能。在此，我们报告一例通过手术切除治疗的多发性肝细胞腺瘤（HCA）病例。
一名18岁男性因蛋白尿入院。他身高176.5厘米，体重126千克，体重指数为40千克/平方米。腹部超声偶然发现肝脏肿瘤。对比增强计算机断层扫描和钆塞酸增强磁共振成像显示，分别在第3/4、8和1段有三个肝肿瘤，大小分别为68毫米、16毫米和9毫米。对最大的肿瘤进行了经皮穿刺活检，诊断为未分类型HCA，并对所有三个肿瘤进行了腹腔镜部分肝切除术。术后过程顺利，患者12天后出院。免疫组织化学检查显示血清淀粉样蛋白A呈阳性，脂肪酸结合蛋白无降低，β-连环蛋白、谷氨酰胺合成酶和细胞角蛋白7呈阴性。因此，这些肿瘤被诊断为炎症型HCA。
我们报告了一例极其罕见的年轻肥胖日本男性多发性切除HCA病例。我们的研究结果表明，肥胖患者肝脏肿瘤的鉴别诊断应考虑HCA。需要进一步考虑临床和分子危险因素的研究，以制定肥胖患者HCA的个体化治疗方案。
