A case of hepatocellular carcinoma with peliotic change in which contrast-enhanced ultrasound was useful

Abstract

The patient was an 82-year-old man. During the course of observation for hepatitis C, a hyperechoic and partially isoechoic mass of 40 mm in diameter was seen in segment S4 of the liver. Posterior echo enhancement and a hypoechoic band on the margin were evident. Dynamic computed tomography (CT) showed strong enhancement on the margin and interior from the late arterial phase through to the portal vein phase, and a somewhat pale highdensity region was seen in the equilibrium phase. On plain magnetic resonance imaging (MRI), hypointensity was seen on T1-weighted imaging and marked hyperintensity on T2-weighted imaging. Hemangioma was suspected with these signal intensities. On Gd-EOB-DTPA-enhanced MRI, the mass presented a strongly enhanced image until the portal vein phase, showed wash-out in the late phase, and displayed a region of uniform hypointensity in the hepatocyte phase. Contrast-enhanced ultrasonography revealed tumor vessels flowing in from the tumor mass margins. In the tumor interior, the central portion was enhanced later than the margin, and the tumor interior was not enhanced in the postvascular phase. Hepatocellular carcinoma was suspected, and partial resection of S4 of the liver was performed. Histologically, the tumor was well-differentiated to moderately differentiated hepatocellular carcinoma, with marked peliotic changes of irregular large and small sizes over an extensive area. In this case of hepatocellular carcinoma with extensive peliotic change within the tumor, contrast-enhanced ultrasonography was useful in diagnosis.