Image of the Month| Volume 46, ISSUE 8, P758, August 2014

Adrenal rest tumour of the liver

Published:April 04, 2014DOI:
      A 58-year-old man with chronic hepatitis B and HIV co-infection underwent abdominal ultrasound for liver cancer screening. A 25 mm focal hypoechoic lesion was discovered in segment VII. Liver function tests and tumour markers levels (α-fetoprotein, CEA, ca 19.9) were normal. On contrast abdominal computed tomography the mass was enhanced heterogeneously in the arterial phase with minimal washout in the portal and delayed phases. On superparamagnetic iron oxide-enhanced magnetic resonance imaging the lesion appeared to be slightly hypointense on T1 (Fig. 1A), hyperintense on T2 fat suppression and clearly hypervascular in the arterial phase (Fig. 1B). Based on the radiological findings and the clinical history a diagnosis of hepatocellular carcinoma (HCC) was suspected. The patient underwent subsegmental liver resection and the postoperative recovery was uneventful. At histology the lesion was diagnosed as an adrenal rest tumour based on morphology and immunostaining (staining was positive for cytokeratin, vimentin, α-inhibin; negative for polyclonal CEA and hepatocyte specific antigen 1). The lesion was adjacent to an area of mature adrenal cortex, surrounded by hepatic tissue (Fig. 1C).
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        • Tajima T.
        • Funakoshi A.
        • Ikeda Y.
        • et al.
        Nonfunctioning adrenal rest tumor of the liver: radiologic appearance.
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