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Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report

BACKGROUND: Hepatocellular adenoma (HCA) is conventionally considered a rare benign liver tumor, but advanced studies have revealed that HCA is heterogeneous, and may include a type that is prone to malignant transformations. Differentiation between well-differentiated hepatocellular carcinoma and f...

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Autores principales: Hoshino, Kouki, Harimoto, Norifumi, Muranushi, Ryo, Hagiwara, Kei, Yamanaka, Takahiro, Ishii, Norihiro, Tsukagoshi, Mariko, Igarashi, Takamichi, Watanabe, Akira, Kubo, Norio, Araki, Kenichiro, Tomomasa, Ran, Nobusawa, Sumihito, Aishima, Shinichi, Nakashima, Osamu, Shirabe, Ken
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205962/
https://www.ncbi.nlm.nih.gov/pubmed/32382834
http://dx.doi.org/10.1186/s40792-020-00853-6
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author Hoshino, Kouki
Harimoto, Norifumi
Muranushi, Ryo
Hagiwara, Kei
Yamanaka, Takahiro
Ishii, Norihiro
Tsukagoshi, Mariko
Igarashi, Takamichi
Watanabe, Akira
Kubo, Norio
Araki, Kenichiro
Tomomasa, Ran
Nobusawa, Sumihito
Aishima, Shinichi
Nakashima, Osamu
Shirabe, Ken
author_facet Hoshino, Kouki
Harimoto, Norifumi
Muranushi, Ryo
Hagiwara, Kei
Yamanaka, Takahiro
Ishii, Norihiro
Tsukagoshi, Mariko
Igarashi, Takamichi
Watanabe, Akira
Kubo, Norio
Araki, Kenichiro
Tomomasa, Ran
Nobusawa, Sumihito
Aishima, Shinichi
Nakashima, Osamu
Shirabe, Ken
author_sort Hoshino, Kouki
collection PubMed
description BACKGROUND: Hepatocellular adenoma (HCA) is conventionally considered a rare benign liver tumor, but advanced studies have revealed that HCA is heterogeneous, and may include a type that is prone to malignant transformations. Differentiation between well-differentiated hepatocellular carcinoma and focal nodular hyperplasia is necessary to diagnose hepatocellular adenoma through imaging; however, the tumor marker of hepatocellular carcinoma, protein induced by vitamin K absence, or antagonist II (PIVKA-II), is rarely positive in hepatocellular adenoma. CASE PRESENTATION: A 44-year-old woman presented to our hospital with complaints of loss of appetite and weight loss. Multidetector row computed tomography revealed a liver tumor (diameter, 80 mm) that was enhanced in the arterial phase. Her serum PIVKA-II level was very high (3327 mAU/mL). Based on the enlargement of the mass and the results of the diagnostic imaging, hepatocellular adenoma or hepatocellular carcinoma was suspected, and we considered the possibility of a malignant transformation due to the high level of serum PIVKA-II; thus, we performed hepatectomy. Histological examination showed brown pigment deposition in the hepatocytes, which was determined to be lipofuscin granules. Based on immunohistochemical findings, the diagnosis was unclassified hepatocellular adenoma. Immunohistochemical examinations revealed that the adenoma cells in the tumor were positive for PIVKA-II. Her serum PIVKA-II level returned to normal after the resection. CONCLUSIONS: We present a case of unclassified hepatocellular adenoma with brown pigment deposition and elevation of serum PIVKA-II level. For the differentiation of liver tumors with high levels of PIVKA-II and hypervascular mass, hepatocellular adenoma should be considered.
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spelling pubmed-72059622020-05-13 Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report Hoshino, Kouki Harimoto, Norifumi Muranushi, Ryo Hagiwara, Kei Yamanaka, Takahiro Ishii, Norihiro Tsukagoshi, Mariko Igarashi, Takamichi Watanabe, Akira Kubo, Norio Araki, Kenichiro Tomomasa, Ran Nobusawa, Sumihito Aishima, Shinichi Nakashima, Osamu Shirabe, Ken Surg Case Rep Case Report BACKGROUND: Hepatocellular adenoma (HCA) is conventionally considered a rare benign liver tumor, but advanced studies have revealed that HCA is heterogeneous, and may include a type that is prone to malignant transformations. Differentiation between well-differentiated hepatocellular carcinoma and focal nodular hyperplasia is necessary to diagnose hepatocellular adenoma through imaging; however, the tumor marker of hepatocellular carcinoma, protein induced by vitamin K absence, or antagonist II (PIVKA-II), is rarely positive in hepatocellular adenoma. CASE PRESENTATION: A 44-year-old woman presented to our hospital with complaints of loss of appetite and weight loss. Multidetector row computed tomography revealed a liver tumor (diameter, 80 mm) that was enhanced in the arterial phase. Her serum PIVKA-II level was very high (3327 mAU/mL). Based on the enlargement of the mass and the results of the diagnostic imaging, hepatocellular adenoma or hepatocellular carcinoma was suspected, and we considered the possibility of a malignant transformation due to the high level of serum PIVKA-II; thus, we performed hepatectomy. Histological examination showed brown pigment deposition in the hepatocytes, which was determined to be lipofuscin granules. Based on immunohistochemical findings, the diagnosis was unclassified hepatocellular adenoma. Immunohistochemical examinations revealed that the adenoma cells in the tumor were positive for PIVKA-II. Her serum PIVKA-II level returned to normal after the resection. CONCLUSIONS: We present a case of unclassified hepatocellular adenoma with brown pigment deposition and elevation of serum PIVKA-II level. For the differentiation of liver tumors with high levels of PIVKA-II and hypervascular mass, hepatocellular adenoma should be considered. Springer Berlin Heidelberg 2020-05-07 /pmc/articles/PMC7205962/ /pubmed/32382834 http://dx.doi.org/10.1186/s40792-020-00853-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Case Report
Hoshino, Kouki
Harimoto, Norifumi
Muranushi, Ryo
Hagiwara, Kei
Yamanaka, Takahiro
Ishii, Norihiro
Tsukagoshi, Mariko
Igarashi, Takamichi
Watanabe, Akira
Kubo, Norio
Araki, Kenichiro
Tomomasa, Ran
Nobusawa, Sumihito
Aishima, Shinichi
Nakashima, Osamu
Shirabe, Ken
Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report
title Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report
title_full Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report
title_fullStr Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report
title_full_unstemmed Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report
title_short Unclassified hepatocellular adenoma with histological brown pigment deposition and serum PIVKA-II level elevation: a case report
title_sort unclassified hepatocellular adenoma with histological brown pigment deposition and serum pivka-ii level elevation: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7205962/
https://www.ncbi.nlm.nih.gov/pubmed/32382834
http://dx.doi.org/10.1186/s40792-020-00853-6
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