Tokyo Women's Medical University Hospital
Dr. Shun-ichi Ariizumi
DATE : 2009
Male, 59 years old.
Primary complaint: None
History of current condition: In July 2008, hepatic dysfunction was found in a health check-up, and abdominal computed tomography (CT) was performed, suggesting HCC.
Hematology and blood chemistry test results: Leukocyte count: 5,820 /µL; hemoglobin: 16 g/dL; platelet count: 9.2 × 104 /µL; aspartate aminotransferase: 30 IU/L; alanine aminotransferase: 46 IU/L; total bilirubin: 0.4 mg/dL; albumin: 4.6 g/dL; ICGR15: 7%; HBs antigen: positive; HBe antigen: negative; HBe antibody: positive; HCV antibody: negative; alpha-fetoprotein: 3 ng/mL; and PIVKA-II: 100 mAU/mL.
The tumor in the anterior segment had approximately equal absorption in simple CT, whereas with contrast CT a high-absorption region 1 cm in diameter was found in the arterial phase, and a faint low-absorption region 2 cm in diameter was found in the equilibrium phase
The pre-contrast image showed a somewhat low-signal region 1 cm in diameter. In the dynamic study, this tumor showed a somewhat high signal 20 s after administration, and a low signal 120 s after administration. However, in the hepatobiliary phase, in the area surrounding this tumor a low-signal region with distinct margins, 2 cm in diameter, was found, and a low-signal region consisting of two masses was also found, linked to the tumor on the medial side (the S6 lesion is shown on p. 6).
Contrast CT arterial phase
Contrast CT equilibrium phase
Pre-contrast
20 s after
administration
60 s after
administration
120 s after
administration
Hepatobiliary phase
Anterior segment resection and partial S6 resection were performed.
The tumors in the anterior segment were one that was 1 cm in diameter, with a swollen sectional surface, and one that was 2 cm in diameter, had indistinct margins, and was a somewhat different color from the surrounding non-cancer hepatic tissues (the S6 findings are shown on p. 7).
(2) Magnification of “a”
(3) Magnification of “b”
(4) Magnification of “d”
(stained with Victoria blue)
(5) Magnification of “c”
(stained with Victoria blue)