PMC5597816_01
Contrast-enhanced magnetic resonance imaging in a 57-year-old patient with alcoholic cirrhosis shows multiple mildly T1 hyperintense lesions in the right and left hepatic lobes (arrows) on pre-contrast T1-weighted images (A, D at different levels) with enhancement on subtracted arterial phase images (B, E) and washout on the subtracted portal venous phase images with pseudo-capsule enhancement (C, F). The lesion in segment III (seen on A, B, C, G, H, I) is hypointense on T2-weighted fat suppressed image (G) and shows signal drop on in-phase (H) compared to out-of-phase images (I), indicating iron content. The lesion in segment III was resected. Note liver surface nodularity compatible with cirrhosis.
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Some of these lesions showed signal intensity drop on in-phase compared to out-of-phase images, indicating iron content (Fig. 1).
Histopathologic images of resected hepatocellular adenoma show: (A) on H&E stain (x40), monotonous hepatocytes without atypia, and absence of portal tracts. (B) on H&E stain (x100) the hepatocytes are arranged in two cell-thick plates. (C) on Trichrome stain (x20), cirrhotic nodules encircled by fibrous septa (arrows), (D) on Perl stain (x100) coarse iron granules in the adenoma, but not in the surrounding liver. The adenoma is diffusely and strongly positive for CRP (immunostain, x20) (E) with patchy serum amyloid A reactivity (immunostain, x20) (F).
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After an inconclusive fine needle aspiration, a laparoscopic surgical resection of two lesions revealed HCAs with positive serum amyloid A (SAA) and C-reactive protein (CRP) on immunohistochemical stains (Fig. 2).