scholarly journals Malignant degeneration of hepatic adenomas to hepatocellular carcinoma

Author(s):  
Neha Goel

Background Hepatic adenomas (HA) are rare, benign proliferations of hepatocytes with high glycogen and fat content that lack normal hepatic architecture. In general, the long-term incidence of malignant degeneration to HCC has not been well characterized. This case report discusses a 37 male with a 10-year history of weekly anabolic steroid abuse who presented with bilobar hepatic adenomas with subsequent malignant degeneration to hepatocellular carcinoma (HCC). Case Presentation Our patient is a 37 old male with a 10-year history of weekly anabolic steroid abuse who presented to his primary care physician (PCP) in July 2013 with intermittent right upper quadrant (RUQ) pain. He was subsequently referred to our cancer center after abdomen/pelvis computed tomography (CT A/P) with oral and intravenous (IV) contrast at an outside hospital revealed two large hepatic masses. The larger mass in segment 2 measured 6.5 x 9.1 cm, while the segment 6/7 mass measured 7.5 x 7.6 cm. Abdomen magnetic resonance imaging (MRI) with and without IV contrast performed at our institution on July 23, 2013 confirmed the presence of the two above noted masses, which were felt to be consistent with probable HA, although HCC could not be definitely ruled out. Of note, his carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) were within normal limits. Percutaneous, ultrasound-guided (US) biopsy of the left lobe mass was consistent with probable HA, although HCC could not be definitely ruled out. Conclusion We present the case of a 37-year-old male 10-year history of weekly anabolic steroid abuse who presented to us in 2013 with HA which had malignant degeneration to HCC while on surveillance over a 2-year period. This case report stresses the importance of having a high clinical suspicion for HA in patients with a history of anabolic steroid abuse and liver masses. Additionally, it reiterates that it can be difficult to differentiate HA from well-differentiated HCC on imaging and/or with a limited biopsy. Furthermore, it is important to keep in mind that the growth of a mass, especially off steroids is highly concerning for malignancy (and masses that fail to regress completely can harbor occult HCC).

2020 ◽  
Author(s):  
Dana M Omer ◽  
Jordan Dozier ◽  
Zongxian Cao ◽  
Hongfa Zhu ◽  
Donald McCain

Abstract Background Hepatocellular carcinoma is a primary liver malignancy often caused by viral hepatitis infection due to chronic inflammation and persistent cytokine release. Although rare, patients may present with large, pedunculated hepatocellular neoplasms that extend into the intra-abdominal space. Here, we present a case report on a 66-year-old male who was found to have such a mass that required careful pre-operative planning to complete a challenging, yet worthwhile, surgical intervention with R0 resection. Case Presentation A 66-year-old Caucasian male with a history of Hepatitis C presented with 4-5 months of abdominal pain, distention and weight loss. Imaging revealed a large heterogenous mass attached to the left lobe of the liver, with compression of the stomach, transverse colon and abdominal wall. Biopsy revealed hepatocellular carcinoma with extensive necrosis and ultimately the patient required surgical intervention, which required resection of omentum, partial gastrectomy, hepatectomy and extensive dissection of the mass to separate the tumor from the remaining intra-abdominal structures and the retroperitoneum. Conclusion Peduncular hepatocellular carcinomas vary in presentation and difficulty of resection. The prognosis and probability of successful surgical intervention depends on the level of differentiation, early staging, size of the neoplasm and invasion into surrounding structures. In this case, R0 resection was successfully performed.


2016 ◽  
Vol 30 (2) ◽  
pp. 73
Author(s):  
Aleksandra Oleśna ◽  
Adam Durczyński ◽  
Piotr Hogendorf ◽  
Michał Nowicki ◽  
Janusz Strzelczyk

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