Matsuura Ko, Oura Shoji, Matsuki Hitomi, Kitano Yurie, Shintani Hiroshi
Department of Gastroenterology, Kobe Tokushukai Hospital, Kobe, JPN.
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada, JPN.
Cureus. 2025 Jun 23;17(6):e86616. doi: 10.7759/cureus.86616. eCollection 2025 Jun.
The differentiation degree of hepatocellular carcinomas (HCCs) well correlates with their aggressiveness. However, except for tumor size and mass border clarity, no preoperative images have been clarified to easily and accurately predict the differentiation degree of HCCs.A 74-year-old man with a liver mass was referred to our hospital. Computed tomography (CT) showed a round and well-circumscribed mass with a slightly lower Hounsfield Unit value than that of the surrounding liver parenchyma, and showed weak early enhancement and a washout pattern. Ultrasound showed an oval mass with very high internal echoes and enhanced posterior echoes. Magnetic resonance imaging of the mass showed slightly low signals on T1-weighted images, high intensity with focal low signals on fat-suppressed T2-weighted images, and weak early enhancement on subtraction images. Due to the elevated serum Protein Induced by Vitamin K Absence or Antagonist-II (PIVKA-II) level in addition to these image findings, the patient underwent a laparoscopic partial hepatectomy under the tentative diagnosis of HCC. Postoperative pathological study showed an oval mass, 65 mm in size, mainly composed of moderately differentiated HCC cells growing in a cord-like fashion with numerous pseudoglandular structures, a thin fibrous capsule encompassing the tumor, and focal areas of well-differentiated HCC cells growing in a thin-trabecular fashion with numerous lipid droplets. Clinicians should note that the absence of low internal echoes indicates the absence of aggressive components even in large HCCs.
肝细胞癌（HCC）的分化程度与其侵袭性密切相关。然而，除肿瘤大小和肿块边界清晰度外，尚无术前影像学检查能明确轻松且准确地预测HCC的分化程度。
一名74岁的肝脏肿块男性患者被转诊至我院。计算机断层扫描（CT）显示一个圆形且边界清晰的肿块，其亨氏单位值略低于周围肝实质，早期强化较弱且呈洗脱模式。超声显示一个椭圆形肿块，内部回声极高且后方回声增强。该肿块的磁共振成像在T1加权图像上显示信号略低，在脂肪抑制T2加权图像上呈高信号并伴有局灶性低信号，在减影图像上早期强化较弱。除了这些影像学表现外，由于血清维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II）水平升高，该患者在初步诊断为HCC的情况下接受了腹腔镜下部分肝切除术。术后病理研究显示一个大小为65毫米的椭圆形肿块，主要由中度分化的HCC细胞呈条索状生长并伴有众多假腺管结构组成，肿瘤周围有一层薄纤维包膜，还有局灶性高分化HCC细胞呈细小梁状生长并伴有众多脂滴。临床医生应注意，即使在大的HCC中，内部低回声的缺失也表明不存在侵袭性成分。
