ABSTRACT
We report a rare case of adenomatous hyperplasia (AH) with malignant transformation, which was observed initially in the liver with chronic hepatitis C. A 47-year-old man was admitted to the hospital and chronic active hepatitis was diagnosed using fine needle biopsy, in addition abdominal computed tomography (CT) and ultrasonography showed multiple and hypovascular liver mass. Needle biopsy of the nodules showed AH. Despite transcatheter arterial embolization and percutaneous ethanol injection therapy (PEIT), the patient was readmitted due to enlargement of the nodules and elevation of alpha-fetoprotein 9 months later. On readmission, the nodules in the liver showed early-stage well-differentiated hepatocellular carcinoma (HCC) histopathologically, that were strongly stained on CT-arteriography and were stained less than the surrounding liver on CT-arterial portography, indicating arterial supply in the nodules and malignant transformation. Thereafter, the patient developed jaundice, and enhanced CT and magnetic resonance imaging showed multiple nodules, which occupied most of the liver, and needle biopsy revealed typical well-differentiated HCC. The patient died of hepatic failure 3 years after the initial admission. In this case, it was confirmed that AH transformed into HCC, which showed a multiple tumor on pathological diagnosis. It has been reported that borderline lesions are curable by less aggressive procedures such as enucleation and PEIT. However, such procedures may not be useful for this type of HCC, which rapidly developed from borderline lesions of the liver.
