A case of hepatic adrenal rest tumor diagnosed by various clinical examination findings

Abstract

A 68-year-old female patient with autoimmune hepatitis receiving prednisolone was referred to our institution for a mass lesion on segment VII of the liver. After undergoing contrast-enhanced ultrasonography, contrast-enhanced CT, Gd-EOB-DTPA-enhanced MRI, and ¹³¹I-adosterol scintigraphy, the mass was suspected to be a hepatic adrenal rest tumor (HART). We then performed a liver biopsy, which revealed adrenal cortex-like cells. Pathological diagnosis identified the mass as a HART. After various hormonal tests, the tumor was confirmed to be hormonally nonfunctional. HARTs are sometimes difficult to distinguish from malignant tumors because of the difficulty in obtaining characteristic image findings, and surgical resection is often selected as the treatment approach. In this rare case, percutaneous liver biopsy and ¹³¹I-adosterol scintigraphy were useful for diagnosis, due to which an unnecessary liver resection was avoided.