Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis

• Published in: World journal of gastroenterology : WJG Vol. 13; no. 8; pp. 1271 - 1274
• Main Authors: Kim, Soo Ryang, Ikawa, Hirotsugu, Ando, Kenji, Mita, Keiji, Fuki, Shuichi, Sakamoto, Michiie, Kanbara, Yoshihiro, Matsuoka, Toshiyuki, Kudo, Masatoshi, Hayashi, Yoshitake
• Format: Journal Article
• Language: English
• Published: United States Department of Gastroenterology, Kobe Asahi Hospital, Japan%Department of Pathology, Keio University School of Medicine, Japan%Department of Surgery, Hyogo Medical Center for Adults, Japan%Department of Radiology, Osaka City University Medical School, Japan%Department of Gastroenterology, Kinki University School of Medicine, Japan%Division of Molecular Medicine & Medical Genetics, International Center for Medical Research and Treatment, Kobe University Graduate School of Medicine, Japan 28-02-2007; Baishideng Publishing Group Co., Limited
• Subjects: Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - pathology; Case Report; Cell Transformation, Neoplastic; Humans; Liver Cirrhosis, Alcoholic - complications; Liver Cirrhosis, Alcoholic - pathology; Liver Neoplasms - complications; Liver Neoplasms - pathology; Male; Middle Aged; 发病步骤; 褪变结节; 酒精性硬化; 高度分化肝细胞癌; Dysplastic nodule; Well-differentiated hepatocellular carcinoma; Alcohol-related liver cirrhosis; Cyclase-associated protein 2; Multistep hepatocarcinogenesis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v13.i8.1271

We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepatocellular 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.