Focal Nodular Hyperplasia-Like Nodule with Reduced Expression of Organic Anion Transporter 1B3 in Alcoholic Liver Cirrhosis

Nobuko Doi; Yasuyuki Tomiyama; Tomoya Kawase; Sohji Nishina; Naoko Yoshioka; Yuichi Hara; Koji Yoshida; Keiko Korenaga; Masaaki Korenaga; Takuya Moriya; Atsushi Urakami; Osamu Nakashima; Masamichi Kojiro; Keisuke Hino

doi:10.2169/internalmedicine.50.4637

CASE REPORTS

Focal Nodular Hyperplasia-Like Nodule with Reduced Expression of Organic Anion Transporter 1B3 in Alcoholic Liver Cirrhosis

Nobuko Doi, Yasuyuki Tomiyama, Tomoya Kawase, Sohji Nishina, Naoko Yoshioka, Yuichi Hara, Koji Yoshida, Keiko Korenaga, Masaaki Korenaga, Takuya Moriya, Atsushi Urakami, Osamu Nakashima, Masamichi Kojiro, Keisuke Hino

Author information

Nobuko Doi
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Yasuyuki Tomiyama
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Tomoya Kawase
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Sohji Nishina
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Naoko Yoshioka
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Yuichi Hara
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Koji Yoshida
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Keiko Korenaga
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Masaaki Korenaga
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan
Takuya Moriya
Department of Pathology, Kawasaki Medical University, Japan
Atsushi Urakami
Department of Digestive Surgery, Kawasaki Medical University, Japan
Osamu Nakashima
Department of Pathology, Kurume University School of Medicine, Japan
Masamichi Kojiro
Department of Pathology, Kurume University School of Medicine, Japan
Keisuke Hino
Departments of Hepatology and Pancreatology, Kawasaki Medical University, Japan

Keywords: alcoholic liver cirrhosis, FNH-like nodule, hepatocellular carcinoma, organic anion transporter, Gd-EOB-DTPA-enhanced MRI

JOURNAL OPEN ACCESS

2011 Volume 50 Issue 11 Pages 1193-1199

DOI https://doi.org/10.2169/internalmedicine.50.4637

Details

Abstract

We report a patient with alcoholic liver cirrhosis who had a 15 mm focal nodular hyperplasia (FNH)-like nodule in the liver. This FNH-like nodule was diagnosed as hepatocellular carcinoma (HCC) mainly based on hypervascularity during the hepatic arterial phase, washout pattern during the equilibrium phase and low signal intensity during the hepatobiliary phase in gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI; it was surgically resected. Its histology exhibited hepatocyte hyperplasia, fibrous septa containing unpaired small arteries accompanied by reactive bile ductules, remarkable iron deposits and sinusoidal capillarization, and was compatible with the diagnosis of an FNH-like nodule. When we analyzed the images of the present nodule retrospectively, low signal intensity on in-phase and isosignal intensity on opposed-phase T1-weighted MRI may have reflected iron deposits in the FNH-like nodule. In addition, a low signal intensity on T2-weighted MRI and no detection in diffusion-weighted MRI may help in distinguishing FNH-like nodules from HCC, since these image findings are inconsistent with typical HCC. Immunohistochemical analysis revealed a markedly reduced expression of organic anion transporter (OATP) 1B3 in this nodule, which implied decreased Gd-EOB-DTPA uptake by hepatocytes and accounted for the low signal intensity during the hepatobiliary phase on Gd-EOB-DTPA-enhanced MRI. To the best of our knowledge this is the first report in which an FNH-like nodule was assessed for OATP1B3 expression.

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