Kanno Hiroki, Maruyama Yuichiro, Sato Toshihiro, Hisaka Toru, Akagi Yoshito, Okuda Koji
Department of Surgery, Kurume University School of Medicine, Kurume, Japan.
Department of Surgery, Kurume University School of Medicine, Kurume, Japan.
Int J Surg Case Rep. 2021 Jun;83:105955. doi: 10.1016/j.ijscr.2021.105955. Epub 2021 May 3.
Hepatocellular adenoma (HCA) is a rare liver tumor. We report a case of a radio-resistant liver tumor that was removed surgically and found to be HCA.
A 37-year-old Japanese man was incidentally diagnosed with a liver tumor. He had no history of viral hepatitis nor metabolic disorders. MRI revealed a tumor enhancing in arterial phase, followed by washout in late phase, and hypointensity in hepatobiliary phase. A diagnosis of hepatocellular carcinoma (HCC) was made and surgery was advised. However, the patient chose proton beam radiotherapy. Although the tumor initially shrunk, it increased in size thereafter. Therefore, anterior sectionectomy was performed. Histology revealed proliferation of hepatocytes without cytologic atypia. On immunohistochemistry, CRP, SAA, GS, L-FABP, and nuclear expression of β-catenin were positive. A final diagnosis of mixed inflammatory and β-catenin activated HCA was made.
HCA is associated with obesity. The present case was a slightly obese man without history of viral hepatitis. In such cases, HCA should be considered. In the present case, proton beam radiotherapy was performed for a diagnosis of HCC. However, the tumor was radio-resistant.
HCA shows an almost equal male to female ratio in the Asian population. Molecular classification is vital in the management of HCA. HCC and HCA are often difficult to differentiate; tumor biopsy is necessary for patients with atypical imaging findings and in younger patients without underlying liver disease. Since the effectiveness of radiation therapy on HCA has not been reported, surgery should be preferred.
肝细胞腺瘤（HCA）是一种罕见的肝脏肿瘤。我们报告一例经手术切除的对放疗耐药的肝脏肿瘤，术后病理检查确诊为HCA。
一名37岁的日本男性偶然被诊断出患有肝脏肿瘤。他没有病毒性肝炎病史，也没有代谢紊乱。磁共振成像（MRI）显示肿瘤在动脉期强化，随后在延迟期廓清，并在肝胆期呈低信号。最初诊断为肝细胞癌（HCC）并建议手术治疗。然而，患者选择了质子束放疗。尽管肿瘤最初缩小，但后来又增大了。因此，实施了肝左外叶切除术。组织学检查显示肝细胞增殖但无细胞异型性。免疫组织化学检查显示，CRP、SAA、GS、L-FABP及β-连环蛋白核表达均为阳性。最终诊断为混合性炎症性和β-连环蛋白激活型HCA。
HCA与肥胖有关。本例患者为轻度肥胖男性，无病毒性肝炎病史。对于此类病例，应考虑HCA的可能。在本例中，因诊断为HCC而进行了质子束放疗。然而，该肿瘤对放疗耐药。
在亚洲人群中，HCA的男女比例几乎相等。分子分型对于HCA的治疗至关重要。HCC和HCA常常难以鉴别；对于影像学表现不典型的患者以及无基础肝病的年轻患者，肿瘤活检是必要的。由于尚未见放疗对HCA有效性的报道，因此手术治疗应作为首选。
