Annals of Case Reports (ISSN: 2574-7754)

case report

Differential Diagnosis of Small HCC Focusing on Pseudolymphoma and Bile Duct Adenoma

Soo Ki Kim1, Takako Fujii1, Soo Ryang Kim1*, Susumu Imoto1, Yumi Fujii1, Kanako Yuasa1, Hisato Kobayashi1, Aya Ohtani1, Yu-ichiro Koma2, Masatoshi Kudo3

1Department of Gastroenterology, Kobe Asahi Hospital, Kobe, Japan

2Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan

3Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan

*Corresponding author: Soo Ryang Kim, Department of Gastroenterology, Kobe Asahi Hospital, 3-5-25 Bououji-cho, Nagata-ku, Kobe, 653-0801, Japan. Tel: +81-78-612-5151; Fax: +81-78-612-5152; Email:

Received Date: 01 October, 2019; Accepted Date: 16 October, 2019; Published Date: 21 October, 2019


With the recent advances in diagnostic imaging, an increasing number of hypervascular hepatic nodules such as Hepatocellular Carcinoma (HCC), Cholangiolocellular Carcinoma (CoCC), Bile Duct Adenoma (BDA) and Lymphoproliferative Disorders (LPD) including pseudolymphoma have been detected. We encountered two cases of pseudolymphoma of the liver and two of bile duct adenoma features of which were compared with those of HCC. Imaging studies of pseudolymphoma of the liver in a 57-year-old woman who had Sustained Virological Response (SVR) to Interferon (IFN) treatment of Hepatitis C Virus (HCV), and a bile duct adenoma in a 39-year-old man, who had sustained SVR by treatment of HCV with Pegylated (Peg) IFN plus ribavirin were analyzed through imaging modalities and histochemical studies. Discussed here is the differential diagnosis of HCC in terms of pseudolymphoma and bile duct adenoma and the importance of avoiding overtreatment of benign lesions.


Bile Duct Adenoma; Chronic Hepatitis C; Hypervascular Nodule; Pseudolymphoma; Small Hepatocellular Carcinoma


HCC: Hepatocellular Carcinoma; Cocc: Cholangiolocellular Carcinoma; BDA: Bile Duct Adenoma; LPD: Lymphoproliferative Disorders; FNH: Focal Nodular Hyperplasia; HCV: Hepatitis C Virus; SVR: Sustained Virological Response; Peg INF: Pegylated Interferon; Ig-G: Immunoglobulin G; Ig-A: Immunoglobulin A; Ig-M: Immunoglobulin M; AFP: Alpha-Fetoprotein; CEA: Carcinoembryonic Antigen; CA19-9: Carbohydrate Antigen 19-9; PIVKA II: Protein-Induced By Vitamin K Absence II; CE-US: Contrast Enhanced Ultrasonography; CE-CT: Contrast Enhanced Computed Tomography; CTA: CT During Arteriography; CTAP: CT During Arterial Portgraphy; Gd-EOB-DTPA-MRI: Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid Magnetic Resonance Imaging; PCR: Polymerase Chain Reaction

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