Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis |
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Authors: | Kim Soo Ryang Ikawa Hirotsugu Ando Kenji Mita Keiji Fuki Shuichi Sakamoto Michiie Kanbara Yoshihiro Matsuoka Toshiyuki Kudo Masatoshi Hayashi Yoshitake |
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Institution: | 1. Department of Gastroenterology, Kobe Asahi Hospital, Japan 2. Department of Pathology, Keio University School of Medicine, Japan 3. Department of Surgery, Hyogo Medical Center for Adults, Japan 4. Department of Radiology, Osaka City University Medical School, Japan 5. Department of Gastroenterology, Kinki University School of Medicine, Japan 6. Division of Molecular Medicine & Medical Genetics, International Center for Medical Research and Treatment, Kobe University Graduate School of Medicine, Japan |
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Abstract: | We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato- cellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase- associated protein 2, a new molecular marker of well- differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis. |
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Keywords: | Multistep hepatocarcinogenesis Dysplastic nodule Well-differentiated hepatocellular carcinoma Alcohol-related liver cirrhosis Cyclase-associated protein 2 |
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