Abstract
A 68-year-old man was referred to our hospital with a 5 cm tumor in S8 of the liver with elevated levels of serum PIVKA-II for further investigation. CT showed a nodular tumor consisting of two different components. The large component which showed little enhancement by contrast enhanced CT, demonstrated a massive fat-containing area by magnetic resonance imaging. The other component which was smaller and next to the large component was well-enhanced in the arterial phase and washed out in the venous phase of contrast enhanced CT, was considered to be typical hepatocellular carcinoma. Based on radiological findings, two differential diagnoses were considered: one large hepatocellular carcinoma (HCC) with 2 components; and a large angiomyolipoma (AML) accompanying with small HCC. Partial hepatic resection was performed. Histopathologically, the tumor was diagnosed as a moderately differentiated HCC of simple nodular type with extra nodular growth as the whole tumor, consisting of the large HCC component with massive fatty change and a small HCC component with little fatty change. Massive fatty change is usually seen in small, well-differentiated HCC, and rarely observed in larger, moderately differentiated HCC. Here, we report a case of a 5-cm moderately differentiated HCC with massive fatty change mimicking AML.
