Adrenal Rest Tumor of the Liver Preoperatively Diagnosed as Hepatocellular Carcinoma

Abstract

Background Hepatic adrenal rest tumors are rare and show similar findings to hepatocellular carcinoma (HCC). It is difficult to distinguish an adrenal rest tumor from HCC due to radiological similarity. We report a case of an adrenal rest tumor in the liver that mimicked HCC radiologically. Case Presentation A 67-year-old female was referred to our hospital due to the finding of a hepatic mass. Enhanced computed tomography revealed a 17 mm well-defined tumor that was enhanced in the arterial phase and washed out in the portal and delayed phase in the posterosuperior subsegment of the right hepatic lobe, and HCC was suspected. We performed a subsegmental resection of the liver. Microscopic findings showed that the tumor was composed of pale cells, and tumor cells were aligned in alveolar or fascicular arrangements in a similar manner to features of adrenocortical tissue. Immunohistochemically, the tumor expressed synaptophysin and CD56. The final histopathologic diagnosis in this case was an adrenal rest tumor of the liver. Conclusions An adrenal rest tumor is similar to HCC in radiological findings. This hepatic tumor should be added to the list of radiological differential diagnoses of hypervascular hepatic tumors.

Hepatic adrenal rest tumor in a patient with multifactorial liver cirrhosis: a case report with CT and MRI findings and pathologic correlation

“…Few case reports of HARTs are currently published in the literature; anyway, most of them appear as hypervascular and fat-containing lesion as in our case [1,[5][6][7]. Interestingly, in other published cases [1,[5][6][7] hepatic adrenal rest tumors had similar location to the current case, in the posterior part of the right hepatic lobe or subcapsular. This localization of HART might be explained by the prevailing migration of aberrant adrenal tissue in this portion of the hepatic lobe.…”

“…Fig 5. Microscopically, the lesion was composed of epithelioid cells with a pale cytoplasm that formed nests or cords accompanied by abundant capillary vessels, similar manner with the features of the adrenocortical tissue.…”

“…Nevertheless, imaging features of HART can be nonspecific, and differential diagnosis with other hepatic lesions should always be considered preoperatively [5,7]. The radiological differential diagnosis should first include hepatic lesions containing fat components and then the hypervascular focal liver lesions [7][8][9][10].…”

“…At imaging, HART generally appears as round, welldefined mass, with subcapsular localization in the right hepatic lobe, showing macroscopic fat-containing and hypervascularity [1,[5][6][7]. These radiological findings can also be present in other focal liver lesions, which range from hepatocellular adenoma and angiomyolipoma (AML) to hepatocellular carcinoma (HCC) with fatty change [1,[5][6][7].…”

“…At imaging, HART generally appears as round, welldefined mass, with subcapsular localization in the right hepatic lobe, showing macroscopic fat-containing and hypervascularity [1,[5][6][7]. These radiological findings can also be present in other focal liver lesions, which range from hepatocellular adenoma and angiomyolipoma (AML) to hepatocellular carcinoma (HCC) with fatty change [1,[5][6][7]. Moreover, patients with chronic liver disease, especially with cirrhosis, who present with a solid focal liver lesion are at a very high risk for having HCC and in this setting the correct diagnosis is particularly relevant and critical for patient's management.…”