Adrenal Rest Tumor of the Liver Preoperatively Diagnosed as Hepatocellular Carcinoma

Background. Hepatic adrenal rest tumors are rare and show similar findings to hepatocellular carcinoma (HCC). It is difficult to distinguish an adrenal rest tumor from HCC due to radiological similarity. We report a case of an adrenal rest tumor in the liver that mimicked HCC radiologically. Case Presentation. A 67-year-old female was referred to our hospital due to the finding of a hepatic mass. Enhanced computed tomography revealed a 17 mm well-defined tumor that was enhanced in the arterial phase and washed out in the portal and delayed phase in the posterosuperior subsegment of the right hepatic lobe, and HCC was suspected. We performed a subsegmental resection of the liver. Microscopic findings showed that the tumor was composed of pale cells, and tumor cells were aligned in alveolar or fascicular arrangements in a similar manner to features of adrenocortical tissue. Immunohistochemically, the tumor expressed synaptophysin and CD56. The final histopathologic diagnosis in this case was an adrenal rest tumor of the liver. Conclusions. An adrenal rest tumor is similar to HCC in radiological findings. This hepatic tumor should be added to the list of radiological differential diagnoses of hypervascular hepatic tumors.

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Hepatic adrenal rest tumor in a patient with multifactorial liver cirrhosis: a case report with CT and MRI findings and pathologic correlation

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00657-0 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Piero Boraschi ◽

Francesca Turini ◽

Francescamaria Donati ◽

Francesca Peruzzi ◽

Annamaria Bartolucci ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cirrhosis ◽

Broad Ligament ◽

Cirrhotic Liver ◽

Arterial Phase ◽

Histopathological Diagnosis ◽

Adrenal Rest Tumor ◽

Right Lobe ◽

Adrenal Rest ◽

The Right

Abstract Background Adrenal rest tumor is an ectopic collection of adrenocortical cells in an extra-adrenal site, more frequently located around the kidney, retroperitoneum, spermatic cord, para-testicular region and broad ligament, but very rarely occurring also in the liver. Hepatic adrenal rest tumor poses a diagnostic challenge in differentiating it from hepatocellular carcinoma, particularly in a cirrhotic liver. Case presentation An 83-years-old male was referred to our hospital by his family doctor for hepatological evaluation due to multifactorial liver cirrhosis. Ultrasound revealed a centimetric hypoechoic nodule in the VI hepatic segment in the context of a liver with signs of cirrhosis and steatosis. The patient first underwent MRI and then CT, which showed a fat containing focal liver lesion in the subcapsular location of the right lobe, strictly adjacent to the homolateral adrenal gland. The nodule was hypervascular in the arterial phase, washed out in the portal-venous and transitional phases, resulting hypointense in the hepato-biliary phase at MR imaging. In the suspicion of a hepatocellular carcinoma, the nodule was surgically removed, and the patient’s postoperative course was unremarkable. The final histopathological diagnosis was of adrenal rest tumor of the liver. Conclusions Hepatic adrenal rest tumor is an extremely rare hepatic tumor, often without any clinical manifestation, that can also occur in the cirrhotic liver as in our case. Although there are not specific imaging findings, the possible diagnosis of HART should be considered when we observe a well-defined lesion in the subcapsular location of the right lobe, with fat containing, hypervascularity after contrast medium injection and vascular supply from the right hepatic artery.

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Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid

Diagnostics ◽

10.3390/diagnostics10100828 ◽

2020 ◽

Vol 10 (10) ◽

pp. 828

Author(s):

Katsutoshi Sugimoto ◽

Tatsuya Kakegawa ◽

Hiroshi Takahashi ◽

Yusuke Tomita ◽

Masakazu Abe ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Predictive Value ◽

Arterial Phase ◽

Liver Imaging ◽

Adrenal Rest Tumor ◽

Contrast Enhanced ◽

Rim Enhancement ◽

Diagnostic Usefulness ◽

Adrenal Rest ◽

Sensitivity Specificity

The Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) was introduced for classifying suspected hepatocellular carcinoma (HCC). However, it cannot be applied to Sonazoid. We assessed the diagnostic usefulness of a modified CEUS LI-RADS for HCC and non-HCC malignancies based on sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Patients with chronic liver disease at risk for HCC were evaluated retrospectively. Nodules ≥1 cm with arterial phase hyperenhancement, no early washout (within 60 s), and contrast defects in the Kupffer phase were classified as LR-5. Nodules showing early washout, contrast defects in the Kupffer phase, and/or rim enhancement were classified as LR-M. A total of 104 nodules in 104 patients (median age: 70.0 years; interquartile range: 54.5–78.0 years; 74 men) were evaluated. The 48 (46.2%) LR-5 lesions included 45 HCCs, 2 high-flow hemangiomas, and 1 adrenal rest tumor. The PPV of LR-5 for HCC was 93.8% (95% confidence interval (CI): 82.8–98.7%). The 22 (21.2%) LR-M lesions included 16 non-HCC malignancies and 6 HCCs. The PPV of LR-M for non-HCC malignancies, including six intrahepatic cholangiocarcinomas, was 100% (95% CI: 69.8–100%). In conclusion, in the modified CEUS LI-RADS for Sonazoid, LR-5 and LR-M are good predictors of HCC and non-HCC malignancies, respectively.

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Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma

Case Reports in Gastroenterology ◽

10.1159/000513803 ◽

2021 ◽

pp. 344-351

Author(s):

Hiroki Kanno ◽

Toshihiro Sato ◽

Ryuta Midorikawa ◽

Satoki Kojima ◽

Shogo Fukutomi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Carbohydrate Antigen ◽

Epithelioid Hemangioendothelioma ◽

Arterial Phase ◽

Rapid Progression ◽

Imaging Findings ◽

Liver Segment ◽

Contrast Enhanced ◽

Well Differentiated ◽

Enhanced Computed Tomography

Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required.

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Successful surgical rescue of delayed onset diaphragmatic hernia following radiofrequency ablation using a thoracoscopic approach for hepatocellular carcinoma: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01213-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Atsushi Morito ◽

Shigeki Nakagawa ◽

Katsunori Imai ◽

Norio Uemura ◽

Hirohisa Okabe ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Small Intestine ◽

Radiofrequency Ablation ◽

Diaphragmatic Hernia ◽

Invasive Treatment ◽

Thoracoscopic Approach ◽

Case Presentation ◽

Medial Segment ◽

Liver Surface ◽

The Right

Abstract Background Radiofrequency ablation (RFA) is widely used as a minimally invasive treatment for hepatocellular carcinoma (HCC). RFA has a low risk of complications, especially compared with liver resection. Nevertheless, various complications have been reported after RFA for HCC; however, diaphragmatic hernia (DH) is extremely rare. Case presentation A 78-year-old man underwent thoracoscopic RFA for HCC located at the medial segment adjacent to the diaphragm approximately 7 years before being transported to the emergency department due complaints of nausea and abdominal pain. Computed tomography revealed a prolapsed small intestine through a defect in the right diaphragm, and emergency surgery was performed. The cause of diaphragmatic hernia was the scar of RFA. We confirmed that the small intestine had prolapsed into the right diaphragm, and we resected the necrotic small intestine and repaired the right diaphragm. Herein, we report a case of ileal strangulation due to diaphragmatic hernia after thoracoscopic RFA. Conclusions Care should be taken when performing thoracoscopic RFA, especially for tumors located on the liver surface adjacent to the diaphragm. Patients should be carefully followed up for possible DH, even after a long postoperative interval.

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A case of Williams syndrome with suspected coexisting ectopic aldosterone-producing tumor in the liver

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-20-0057 ◽

2020 ◽

Vol 2020 ◽

Author(s):

Shuhei Baba ◽

Arina Miyoshi ◽

Shinji Obara ◽

Hiroaki Usubuchi ◽

Satoshi Terae ◽

...

Keyword(s):

Williams Syndrome ◽

Primary Aldosteronism ◽

High Plasma ◽

Plasma Aldosterone ◽

Adrenal Tumors ◽

Venous Sampling ◽

Plasma Aldosterone Concentration ◽

Adrenal Rest Tumor ◽

Adrenal Rest ◽

The Right

Summary A 31-year-old man with Williams syndrome (WS) was referred to our hospital because of a 9-year history of hypertension, hypokalemia, and high plasma aldosterone concentration to renin activity ratio. A diagnosis of primary aldosteronism (PA) was clinically confirmed but an abdominal CT scan showed no abnormal findings in his adrenal glands. However, a 13-mm hypervascular tumor in the posterosuperior segment of the right hepatic lobe was detected. Adrenal venous sampling (AVS) subsequently revealed the presence of an extended tributary of the right adrenal vein to the liver surrounding the tumor. Segmental AVS further demonstrated a high plasma aldosterone concentration (PAC) in the right superior tributary vein draining the tumor. Laparoscopic partial hepatectomy was performed. The resected tumor histologically separated from the liver was composed of clear cells, immunohistochemically positive for aldesterone synthase (CYP11B2), and subsequently diagnosed as aldosterone-producing adrenal adenoma. After surgery, his blood pressure, serum potassium level, plasma renin activity and PAC were normalized. To the best of our knowledge, this is the first report of WS associated with PA. WS harbors a high prevalence of hypertension and therefore PA should be considered when managing the patients with WS and hypertension. In this case, the CT findings alone could not differentiate the adrenal rest tumor. Our case, therefore, highlights the usefulness of segmental AVS to distinguish adrenal tumors from hepatic adrenal rest tumors. Learning points: Williams syndrome (WS) is a rare genetic disorder, characterized by a constellation of medical and cognitive findings, with a hallmark feature of generalized arteriopathy presenting as stenoses of elastic arteries and hypertension. WS is a disease with a high frequency of hypertension but the renin-aldosterone system in WS cases has not been studied at all. If a patient with WS had hypertension and severe hypokalemia, low PRA and high ARR, the coexistence of primary aldosteronism (PA) should be considered. Adrenal rest tumors are thought to arise from aberrant adrenal tissues and are a rare cause of PA. Hepatic adrenal rest tumor (HART) should be considered in the differential diagnosis when detecting a mass in the right hepatic lobe. Segmental adrenal venous sampling could contribute to distinguish adrenal tumors from HART.

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Quantitative Analysis of Enhanced Computed Tomography in Differentiating Cystitis Glandularis and Bladder Cancer

BioMed Research International ◽

10.1155/2020/4930621 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hui Hua ◽

Yuanxiang Gao ◽

Jizheng Lin ◽

Feng Hou ◽

Jun wei Wang ◽

...

Keyword(s):

Bladder Cancer ◽

Quantitative Analysis ◽

Sensitivity And Specificity ◽

Arterial Phase ◽

Relative Enhancement ◽

Enhanced Ct ◽

Venous Phase ◽

Enhanced Computed Tomography ◽

Quantitative Indicators ◽

Delayed Phase

Objective. This study was performed to assess the value of quantitative analysis of enhanced computed tomography (CT) values in the differential diagnosis of bladder cancer and cystitis glandularis (CG). Methods. Eighty patients with bladder masses (39 with CG and 41 with bladder cancer) who underwent enhanced CT were retrospectively reviewed. The CT enhancement values of the lesion and normal bladder wall in the arterial phase, venous phase, and delayed phase were measured. The relative enhancement CT values (relative enhancement CT value=enhancement CT value of lesion−enhancement CT value of normal bladder) in the arterial phase, venous phase, and delayed phase were also calculated. The pathological results were used as the gold standard, and the area under the curve (AUC), sensitivity, and specificity were calculated for the six groups of quantitative indicators (enhanced CT values and relative enhanced CT values of CG and bladder cancer in the arterial, venous, and delayed phases). We performed the leave-group-out cross-validation method to validate the accuracy, AUC, sensitivity, and specificity. The differences in accuracy, AUC, sensitivity, and specificity among the six groups of quantitative indicators were compared by the t-test. Results. In a combined analysis of the AUC, sensitivity, and specificity performance, the best indicator was the arterial-phase relative enhancement CT value with a cut-off of 25.85 HU (AUC, 0.966; sensitivity, 95.1%; specificity, 92.3%). We used the 100-times leave-group-out cross-validation method to validate the accuracy, AUC, sensitivity, and specificity. Arterial-phase relative enhancement CT values showed the highest AUC and accuracy among the six groups, with statistical significance (P<0.05). Conclusion. Quantitative analysis of enhanced CT is of great clinical value in the differential diagnosis of CG and bladder cancer.

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Hepatic adrenal rest tumor mimicking hepatocellular carcinoma

The Korean Journal of Hepatology ◽

10.3350/kjhep.2010.16.3.338 ◽

2010 ◽

Vol 16 (3) ◽

pp. 338 ◽

Cited By ~ 16

Author(s):

Yong Moon Shin

Keyword(s):

Hepatocellular Carcinoma ◽

Adrenal Rest Tumor ◽

Adrenal Rest

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Adrenal Rest Tumor from the Greater Omentum Mimicking Exophytic Hepatocellular Carcinoma (HCC): A Case Report

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2010.63.1.45 ◽

2010 ◽

Vol 63 (1) ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

Hyung Jo Yoon ◽

Seong Hoon Kim ◽

Jae Bok Park ◽

Hyun Chul Jo ◽

Mi Young Son ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Case Report ◽

Greater Omentum ◽

Adrenal Rest Tumor ◽

Adrenal Rest

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Primary leiomyoma of the ureter: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02960-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Shingo Morinaga ◽

Shigeyuki Aoki ◽

Motoi Tobiume ◽

Genya Nishikawa ◽

Hiroyuki Muramatsu ◽

...

Keyword(s):

Malignant Tumors ◽

Histopathological Examination ◽

Urine Cytology ◽

Benign Tumors ◽

Case Presentation ◽

Old Japanese ◽

Retrograde Pyelogram ◽

History Of ◽

The Right ◽

Enhanced Computed Tomography

Abstract Background Only 14 cases of leiomyoma with ureteral origin have been reported previously. Such primary leiomyomas often present as hydronephrosis, making the diagnosis difficult. Radical nephroureterectomy is often performed because of the possible diagnosis of a malignant tumor. We report the 15th case of primary leiomyoma with a ureteral origin. Case presentation A 51-year-old Japanese man presented with a chief complaint of asymptomatic gross hematuria with a history of hypertension. Enhanced computed tomography showed a tumor at the upper part of the right ureter that appeared to be the cause of hydronephrosis and contracted kidney; no retroperitoneal lymphadenopathy and distal metastasis were observed. A well-defined 20-mm (diameter) defect was identified at the upper of the right ureter on retrograde pyelogram with no bladder cancer on cystoscopy. Urine cytology and right divided renal urine cytology findings were negative. Laparoscopic nephroureterectomy was performed, and the extracted tumor measured 20 × 13 mm. Histopathological examination revealed primary leiomyoma with no recurrence 16 months after the operation. Conclusions Preoperative examination with the latest available ureteroscopic technology can help preserve renal function in the case of benign tumors by enabling preoperative ureteroscopic biopsy or intraoperative rapid resection. Moreover, nephroureterectomy is recommended in the case of preoperative suspicion of ureteral malignant tumors.

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