Korean J Gastroenterol.  2019 May;73(5):303-307. 10.4166/kjg.2019.73.5.303.

Cystic Degeneration of Hepatocellular Carcinoma Mimicking Mucinous Cystic Neoplasm

• Lee J
• Lee N
• Yoon HK
• Lee YJ
• Park SJ

• KMID: 2447601
• DOI: http://doi.org/10.4166/kjg.2019.73.5.303

Abstract

Spontaneous regression of tumors is an extremely rare event in hepatocellular carcinoma (HCC) with only a few reports available. With the accumulation of clinical information and tumor immunogenetics, several mechanisms for the cystic changes of HCC have been suggested, including arterial thrombosis, inflammation, and rapid tumor growth. This paper reports an uncommon case of the partial regression of HCC, which was initially misdiagnosed as a mucinous cystic neoplasm of the liver due to the unusual radiologic findings. A 78-year-old female with the hepatitis B virus and liver cirrhosis presented with an approximately 5 cm-sized cystic mass of the liver. From the radiologic evidence of a papillary-like projection from the cyst wall toward the inner side, the initial impression was a mucinous cystic neoplasm of the liver. The patient underwent a surgical resection and finally, cystic degeneration of HCC, in which approximately 80% necrosis was noted. This case suggests that if a cystic neoplasm of liver appears in a patient with a high risk of HCC on a hepatobiliary imaging study, it is prudent to consider the cystic degeneration of HCC in a differential diagnosis.

Keyword

Liver neoplasms; Magnetic resonance imaging; Diagnostic errors

MeSH Terms

Aged
Carcinoma, Hepatocellular*
Diagnosis, Differential
Diagnostic Errors
Female
Hepatitis B virus
Humans
Immunogenetics
Inflammation
Liver
Liver Cirrhosis
Liver Neoplasms
Magnetic Resonance Imaging
Mucins*
Necrosis
Thrombosis
Mucins

Figure

• 

  Fig. 1 Computed tomography scan shows ill-defined, 4×5 cm sized cystic mass located in segment V/VIII with peripheral enhancement in the arterial phase, panel (A) and venous phase, panel (B).

• 

  Fig. 2 Dynamic magnetic resonance imaging shows; pre-enhancement phase (A), arterial phase (B), portal phase (C), papillary-shaped projection from cyst wall toward the inner side at two-minute delay phase (D).

• 

  Fig. 3 Remnant hepatocellucar carcinoma cell surrounding broad necrosis (A, H&E, ×40), pleomorphic and undifferentiated malignant cell (B, H&E, ×200).

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