Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis

Soo Ryang Kim, Hirotsugu Ikawa, Kenji Ando, Keiji Mita, Shuichi Fuki, Michiie Sakamoto, Yoshihiro Kanbara, Toshiyuki Matsuoka, Masatoshi Kudo, Yoshitake Hayashi

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We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepatocellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase-associated protein 2, a new molecular marker of well-differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis.

Original languageEnglish
Pages (from-to)1271-1274
Number of pages4
JournalWorld Journal of Gastroenterology
Issue number8
Publication statusPublished - 2007 Feb 28



  • Alcohol-related liver cirrhosis
  • Cyclase-associated protein 2
  • Dysplastic nodule
  • Multistep hepatocarcinogenesis
  • Well-differentiated hepatocellular carcinoma

ASJC Scopus subject areas

  • Gastroenterology

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