Abstract
The patient was a woman in her 70s. She was referred to our hospital due to abnormal blood tests without any chief complaint. Her medical history included chronic hepatitis B, hysterectomy, post-oophorectomy, and hypertension. Her blood test revealed AFP 2.5 ng/ml, which was within the normal range, and PIVKA-II 216 mAU/ml, which was high, but it had decreased to 20 mAU/ml the day before surgery. There were no other particular findings. Ultrasonography showed a 14×12-mm hypoechoic space-occupying lesion with a relatively uniform, well-defined interior and irregular contours in segment 2 (S2). There was no obvious capsular structure. Because of its proximity to the heart, the blood flow signal on color Doppler was difficult to evaluate due to the beating heart. Plain CT showed a pale low-absorption area. As for EOB-MRI, T1-weighted images showed a 17-mm low-signal nodule in the hepatocellular phase at S2. On angiographic CT, tumor staining was seen in S2, and CTAP showed a 17-mm hypo-absorptive area. CTAP showed a 17-mm low-absorption area, part of which was stained by CTHA. Based on these results, intermediate differentiated hepatocellular carcinoma was suspected. Pathology revealed necrotic nests accompanied by a fibrous capsule and surrounded by an infiltrate of chronic inflammatory cells and droplet histiocytes. The cellular ghost was considered to be the image of a resolved hepatocellular carcinoma.
We report a case of hepatocellular carcinoma that was thought to have resolved spontaneously. Contrast-enhanced ultrasonography revealed characteristic findings.
