Atypical Hepatocellular Neoplasm With Peliosis in Cirrhotic Liver Versus Hepatocellular Carcinoma

Abstract

Atypical hepatocellular neoplasm (AHN) is an adenoma-like hepatic tumor that even occurs in noncirrhotic liver of males (any age) or females ≥50 years old, or associates focal atypical features.In this article, 2 unusual cases diagnosed in elderly cirrhotic patients, unrelated to steroids, are presented.The first case was incidentally diagnosed in an 83-year-old female. During laparoscopic surgery for cholecystectomy, hemoperitoneum was installed and laparotomy was necessary to remove a 70-mm nodular encapsulated hepatic tumor that was microscopically composed by hepatocyte-like cells with clear cytoplasm, arranged in 1- to 2-cell-thick plates and intermingled with areas of peliosis, negative for alpha fetoprotein (αFP), p53, and keratin 7, with low Ki67 index and intact reticulin framework. The second case was incidentally diagnosed at ultrasound examination in a 66-year-old male. The surgical specimen was a 50-mm solid multinodular tumor that microscopically consisted of 3-cell-thick plates of hepatocyte-like cells with acinar, pseudoglandular, and trabecular architecture, intermingled with peliotic areas, without nuclear atypia and disintegrated reticulin framework. Both of the cases occurred in cirrhotic liver. The tumor cells were marked by AE1/AE3 keratin, displayed a Ki67 index < 5% and were negative for αFP, p53, and keratin 7. No recurrences or any other disorder occurred 6 months after surgery.In cirrhotic liver, adenomas with peliosis that do not satisfy all the diagnosis criteria synthesized in the article should be considered AHNs and differential diagnosis includes hepatocellular carcinoma but also focal nodular hyperplasia, regenerative nodules, and dysplastic nodules. This histological entity is not yet included in the WHO Classification list.

A rare case of peliosis hepatis in primary immune deficiency

“…These bloodfilled lesions can appear similar to hemangiomas on imaging, although hemangiomas highly over-express CD34, which is a marker for reticulin and fibrous tissue. [16][17][18] CD34 positivity is also noted in normal liver tissue. This patient's pathology is not consistent with hemangioma ( Figure 2).…”

Serum microRNA panel for early diagnosis of the onset of hepatocellular carcinoma

“…Because of the limited amount of specimens of hepatocellular adenomas, [26] the diagnosis efficiency of 3-miRNA panel among HCC and adenomas did not evaluated in this study. Additionally, some studies have reported that miRNAs have great potential as biomarkers for the diagnosis of cholangiocarcinomas.…”

Assessment of small hepatocellular carcinoma: perfusion quantification and time-concentration curve evaluation using color-coded and quantitative digital subtraction angiography

“…[13] However, it may be difficult to distinguish between HCC and atypical hepatocellular neoplasm with peliosis in cirrhotic liver. [14] Peliosis hepatis is a rare tumor-like lesion that composed of multiple blood-filled cavities that are difficult to distinguish from other hepatic lesions unless examined by biopsy. [15,16] Imaging characteristic of peliosis hepatis is arterial enhancement without rapid washout, [16] which may be similar to type II (plateau pattern) time-concentration curve in QDSA.…”