A Case of hepatocyte nuclear factor 1α-inactivated hepatocellular adenoma, involving anomalous portal tract, difficult to be differentiated from FNH-like lesion

概要

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A 26-year man visited a nearby clinic because of epigastralgia and a large hepatic mass. He was referred to our hospital. According to the laboratory date, the levels of ALT, AST, WBC and CRP were increased. On the abdominal CT scan, the hepatic large mass was found in the S4 segment. The abdominal dynamic CT scan indicated no enhanced area on the central portion. The peripheral portion of the mass was irregularly enhanced. As various diagnosis containing hepatocellular carcinoma, hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) were suspected and bleeding from the tumor was possible, the patient underwent hepatectomy of left lobe. The hepatic large mass was completely encapsulated with a clear boundary and hematoma existed in the central portion of the mass. On the peripheral portion of the mass, there was benign liver tissue and anomaly of the portal tract. According to the clinical date and the pathology of anomalous portal tract, we firstly suspected FNH-like lesion. Ultimately, we diagnosed HCA according to the L-FABP immunostaining. This case indicated the disparity in new immunohistochemical diagnosis and clinical diagnosis, at the point of presence of anomalous portal tract and absence of the characteristic, like pill, in hepatocellular adenoma.