Korean J Gastroenterol.  2009 Jun;53(6):378-382. 10.4166/kjg.2009.53.6.378.

A Case of Hepatocellular Carcinoma Combined with Liver Abscess

• Yeom JO
• Yoon SB
• Kim JG
• Oh JH
• Jeon EJ
• Jeong JJ
• Choi SW
• Lee S

• KMID: 1792756
• DOI: http://doi.org/10.4166/kjg.2009.53.6.378

Abstract

Hepatocellular calcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer-related deaths worldwide. It is important to diagnose HCC exactly before management is attempted. But, the clinical presentations and radiologic findings of liver abscess, HCC, and metastatic tumor to the liver may be quite similar, and procedures such as serum tumor marker assay, computerized tomography, and ultrasonography of the liver cannot make a specific diagnosis. We report a case of HCC successfully diagnosed by surgery which was misconceived as liver abscess and not improved by medical treatment.

Keyword

Carcinoma; Hepatocellular; Liver abscess

MeSH Terms

Carcinoma, Hepatocellular/complications/*diagnosis/pathology
Humans
Liver/ultrasonography
Liver Abscess/complications/*diagnosis/pathology
Liver Neoplasms/complications/*diagnosis/pathology
Male
Middle Aged
Tomography, X-Ray Computed

Figure

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  Fig. 1. Abdominal ultrasonography. Ill defined hypoechoic area was seen in right hepatic lobe, just lateral to the gallbladder. Minimal intrahepatic ductal dilatations and mild gallbladder wall thickening were noted.

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  Fig. 2. Abdominal CT. A 10×7 cm sized cluster of low attenu-ation lesion was noted at segment 5 and 8. These lesions have enhancing walls. The surrounding parenchyma showed hyperemia. Multiple lymphadenopathy were noted at hepatoduodenal ligament, portocaval space, and upper paraaortic space.

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  Fig. 3. Follow-up abdominal CT. Previousely noted large hepatic mass at segment 5 and 8 was further enlarged. Multiple reactive lymphadenopathy at hepatoduodenal ligament, portocaval space, and upper paraaortic space were seen.

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  Fig. 4. Operative finding. Wedge resection was done. Grossly, hard and nodular surface was noted.

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  Fig. 5. Histological findings. (A) Extensive necrosis (left side) and intact tumor area (right side) were noted (H&E, ×40). (B) Tumor cells form trabeculae or nests, were wrapped by endothelial cells or thin fibrous stroma. The infiltration of acute and chronic inflammatory cells was noted in the stroma (H&E, ×200). (C) Tumor cells were large and pleomorphic with prominent nucleoli and abundant granular cytoplasm. Atypical mitoses were frequently observed (H&E, ×400). (D) Immunohistochemical stain for CK19 was positive (H&E, ×400).

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