Adrenal cortical carcinoma mimicking a hepatic tumor in a hepatitis C virus (HCV)-positive case

Abstract

An asymptomatic, 38-year-old, HCV-positive female had a 5-cm hepatic nodule detected by routine health check. Various imaging modalities (ultrasonography, CT, MRI and Angio-CT) demonstrated a hypervascular nodule with homogenous enhancement in the arterial phase and washout in the late phase in segment 7. Histopathologically, the tumor biopsy showed mild atypia suggestive of well-differentiated HCC or a dysplastic nodule. As these findings did not correlate with the imaging diagnosis, the patient was referred to our hospital. We performed contrast-enhanced ultrasonography (CEUS) with Levovist. Tumor feeding arteries, mainly from the posterior branch of the right hepatic artery, and homogenous enhancement were seen in the arterial phase and washout was evident at one minute. While CEUS findings were not typical for HCC, we concluded that this tumor was malignant and performed a posterior segmentectomy of the liver. The resected specimen was a non-encapsulated, yellowish tumor. The microscopic findings were consistent with an adrenal cortical tumor with minimal invasion into the adjacent liver parenchyma, leading to a final diagnosis of adrenal cortical carcinoma. This case suggests that adrenal tumors may be mistaken for a segment 7 hepatic tumor due to the close anatomical relationship between the liver and adrenal gland.