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Digestive and Liver Disease

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Digestive and Liver Disease

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Hepatic ectopic adrenocortical adenoma mimicking hepatocellular carcinoma

Huan Tian, Linmeng Li, Yubo Liu, Zhiqun Wang* Department of Radiology, Aerospace Center Hospital, No. 15, Yuquan Road, Haidian District, Beijing 100049, China

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A 66-year-old woman was referred to our hospital for an in- cidentally detected liver lesion. She denied a history of chronic liver disease. Laboratory tests revealed only a mildly elevated to- tal bilirubin, while tumor marker results were normal. Contrast enhanced ultrasound showed the lesion had lower echo than the surrounding liver, rapid and uneven enhancement in the arte- rial phase, and local washout in the portal venous phase (Fig. 1). Enhanced computed tomography demonstrated a low-density le- sion that protruded outwards in the right posterior lobe of the liver. Non-contrast scanning revealed slightly uneven density. Dur- ing the arterial phase, distinct patchy enhancement occurred at the lesion’s right margin and center. Maximum intensity pro- jection reconstruction indicated that the lesion was supplied by

the right hepatic artery. In the venous phase and delayed phase, the enhancement decreased (Fig. 1). Based on the above imag- ing findings, a malignant tumor was highly suspected. Conse- quently, the patient underwent laparoscopic partial hepatectomy. The golden-yellow, soft tumor specimen was pathologically diag- nosed as hepatic ectopic adrenal cortical adenoma. Immunohisto- chemistry results showed Vimentin (+), « - inhibin (+), CD56 (+) (Fig. 2).

Hepatic ectopic adrenocortical adenoma is rare [1,2]. Due to its rarity and non-specific imaging, accurate diagnosis is challenging for radiologists, as it can be misdiagnosed as other liver tumors. In this case, the fact that the lesion was supplied by the right hepatic artery added further confusion to the diagnosis.

* Corresponding author. E-mail address: wangzhiqun@126.com (Z. Wang).

Fig. 1. Contrast-enhanced ultrasound and computed tomography images. (a) During the non-contrast phase, the echo of the lesion was lower than that of the surrounding liver tissue. (b) The color Doppler flow spectrum showed that there is less blood flow within the lesion. (c) In the arterial phase, part of the lesion in the right lobe of the liver showed rapid enhancement, presenting uneven enhancement. (d) In the portal venous phase, there was local rapid washout. (e) The non-enhanced scan demonstrated a patchy low-density lesion in the right posterior lobe of the liver, approximately 36 x 29 x 30 mm in size, with a distinct boundary. (f-h) In the arterial phase, tortuous and small vascular shadows arising from the right hepatic artery (red arrows) could be observed surrounding the lesion, and the nodular area at the center of the lesion showed marked enhancement. (i-j) In the venous phase and the delayed phase, the enhancement of the lesion slightly diminished.

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Fig. 2. (a) Hematoxylin-eosin staining (× 40). (b-d) Immunohistochemistry showed Vimentin (+), a - inhibin (+), CD56 (+), respectively (× 40).

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Conflict of interest	Ethics approval
The authors declared that they have no conflicts of interest to	Ethics has been exempted by Ethics Committee of the Aerospace Center Hospital for retrospective case report.
this work.
Funding	References
None.	[1] Zhang JY, Luo Y, Liu F, et al. Hepatic isolated ectopic adrenocortical ade- noma mimicking metastatic liver tumor. Hepatobiliary Pancreat Dis Int 2021;20(1):83-6.
Patient consent for publication	[2] Chen J, Wan X, Lu Y, et al. An ectopic adrenocortical oncocytic adenoma in the liver highly mimicking hepatocellular carcinoma: case report and literature re-
Consent obtained directly from patient.	view. Diagn Pathol 2021;16(1):58.